WORLD HEALTH ORGANIZATION REGIONAL OFFICE FCR THE WESTERN PACIFIC REGIONAL COMMITTEE WP/RC7/3 Add.1 20 July 1956 Seventh Session Manila 7-13 September 1956 ENGLISH ONLY SIXTH ANNUAL REPORT OF THE REGIONAL DIRECTOR TO TUE REGIORAL COMMITTEE FCR THE WESTERN PACIFIC Page 39 - The Designated PoliOmyelitis Centre, Singapore Viet N~ should be added to the list of countries served by this centre. - The Designated Po1iosrelitis Centre, Japan Philippin~s should be added to the list of countries served by this centre.
WORID HEALTH ORGANIZATION REGIONAL CCMMITTEE Seventh Session Manila 7-13 September 1956 SIXTH ANNUAL REPCRT OF THE REGIONAL DIRECTOR TO THE REGIONAL CFFICE FOR THE WESTERN PACIFIC WP!RC7!3 12 July 1956 ORIGINAL: ENGLISH REGIONAL COMMITTEE FOR THE WESTERN PACIFIC 1 2 3 4 5 6 7 CONTENTS PART I - GENERAL INTRODUCTION ............ " ..................... , ....... " ... " ... . THE REGIONAL CrnMITTEE · ..................................... . REGIONAL OFFICE .................... " ......................... . 3.1 3.2 3.3 3.4 3.5 3.6 3.7 General ................... " .. , ....................... . Accommodation ........................................... . Organizational structure and . area representa ti ve s •.•.•••.•••..•.••••••••••••••••••• Regional Office staff •••••.•••.••.•••••••••••••••••••• Pr'o ject staff ............•...........................• Other personnel matters •••••••••••••••••••.•.••••••••• Pr'oject activities ..................................•• AGREEMENTS WITH GOVERNMENTS .................................. CO-OPERATION WITH THE UNITED NATIONS AND OTHER AGENCIES ...... 5.1 5.2 5.3 5.4 5.5 With the United Nations ............................... With other United Nations Agencies .................... 5.2.1 5.2.2 5.2.3 5.2.4 5.2.5 UNICEF · ..................................... . Technical Assistance Programme ............... .......................................... FAO UNESCO · ..................................... . Other Specialized Agencies ................... With bilateral agencies ............................... With non-governmental organizations· ................... South Pacific Commission .............................. NATIONAL PUBLIC-HEALTH PROGRM~ CO-ORDINATION COMMITTEES •••• 6 .. 1 6.2 China ................................................. Philippines ........................................... PUBLIC INFORMATION ........................................... 7.1 7.2 7.3 7.4 General Exhibits ............................................... .............................................. World Health Day Other publicity ...................................... • •••••••••••••••••••••••••••••••••••••• Page 1 2 4 4 5 5 6 7 7 8 B B B 9 9 9 10 10 10 11 11 11 11 II 12 12 12 13 13 14 1 2 3 4 5 CONTENTS PART II - GENERAL STATEMENT OF ACTIVITIES IN THE REGION PUBLIC-HEALTH SERVICES ............................ ., ........ . 1.1 1.2 1.3 1.4 1.5 1,6 Assistance to governments in the developing and strengthening of their health services ........... Maternal and Child Health ............................ Nurs ing .............................................. . Environmental Sanitation ••••••••••••••••••••••••••••• Health Education ••••••••••••••••••••••••••••••••••••• Mental Health . ~ ........................ ., ............ . EDUCATION AND TRAINING •••• I ••••••••••••••••••••••••••••••••• Assistance to Educational Institutions ••••••••••••••• Fellowships •••••••••••••••••••••••••••••••••••••••••• Educational Meetings ••••••••••••••••••••••••••••••••• COMMUNICABLE DISEASES .... , ............... -..... ', .... ", ......... . 3.1 3.2 3.3 14a.laria Control ••••••••••••• ', •• " •••••••••••• ,", •••••••• Tu'berculosis and BeG ••••••••••• ' •••• '.: .................. . Venereal diseases and Treponematoses .••••••••••••••••• 3.3.1 3.3.2 Yaws ...... ~ ...... ~.~~~~ .•.....•..•••...•..•• Venereal Diseases ~ ... ~ ..........•........••• ENDEMO-EPIDEMIC DISEASES ...... '. '. ' ... ' ......................... . 4.1 Filariasis and other insect-borne diseases ........... 4.1.1 4.1.2 Filariasis •..••..•••••.•.•••...••.•••••••••• Arthropod-borne Virus Diseases •..••••••••••• Lepro sy- .............................................. . Poliomyeli ti s •••.•••..•••••.••••.••••••••.••••••••••• 4.3.1 4.3.2 Regional Poliomyelitis Centres •••••••••••••• Other ••.•••.• " •••••••••.••••••••••••••••••• " OTHER ACTIVITIES ............................................ 5.1 The Role of Health Physics Education and Training in the Use of Atomic Energy •••••••••••••••••••••••••• Page 16 16 18 20 21 22 24 26 26 28 29 30 30 31 33 33 34 35 35 35 36 36 37 37 39 40 40 ANNEXES CONTENTS PART III ~ PROJECTS IN OPERATION 1 JULY 1955 - 30 JUNE 1956 I LIST OF REGIONAL OFFICE POSTS II CONSULTANTS EMPLOYED DURING THE YEAR III PROJECT AND REGIONAL OFFICE INTERNATIONAL STAFF EMPLOYED AS OF 30 JUNE 1956 IV GEOGRAPHICAL DIsrRIBUTION OF INTERNATIONAL STAFF TERMINATED OR TRANSFER.R.ED V LIST OF SUPPLEMENTARY AGREEMENTS SIGNED WITH MEMBER COUNTRIES DURING THE PERIOD 1 JULY 1955 TO 30 JUNE 1956 VI TRAVEL UNDERTAKEN DURING PERIOD UNDER REVIEW VII FELLOtlSHIP AWARDS VIII PLANNING INDIVIDUAL FELLa-lSHIPS PART I .. GENERAL 1 INTRODUCTION W P/RC 7/3 Page 1 The planning and development of the programme for the Western Pacific Region during the period under review have followed the general principles governing the Organization I s programme of work co vering a specific period, with the necessary modifications to suit conditions existing in the countries and territories within the area. The various resolutions passed by the Regional Committee have also been taken into consideration and adhered to as closely as possible. The continuation of existing projects, the objectives of which had not yet been attained; the redefinition of others, which had been in operation for some time and in which changes had to be made after review of their achievements and present circumstances; the initiation of new ones aimed at further strengthening public-health administration in various countries; the training of more health personnel, both professional and auxiliary; assisting in the control of communicable diseases, and the introduction of projects in newer fields of interest were some of the. main features of the regional programme. The period was also characterized by the completion of a number of project~as well as of the first phase of others, follow-up of which has been, and is being, undertaken. The needs of the countries and territories, as reflected in their requests and approved by the Regional Committee and the World Health Assembly, have been met as closely as possible and as expeditiously as circumstances would permit. In line with the newer developments in public health and the policy of the Organization to include these in its programme, new activities have been undertaken wherever these were found practicable and feasible. This has led to trials made on ambulatory therapy and chemo- prophylaxis in tuberculosis control and on the new approach in leprosy control, results of which are keenly awaited for possible wider application, not only in the countries where these pilot projects were started, but also in other countries of the Region with similar health problems. Activities directed to the eradication of malaria have been started and co-ordination of malaria-control work, on an inter-country as well as inter-regional basis, has had an auspicious beginning in at least two groups of countries in the Region in preparation for the eradication of this disease. Increased interest and co-operation in the Malaria Eradication Special Account have been amply demonstrated, with countries such as Brunei and China contributing to the account and possible contributions from others already in sight, thus helping to give assurance of the continuity of the projects launched in this direction. In addition to its country and territory programme, the Regional Office has also been active in respect of various intra- and inter-regional activities. Participation of the regional secretariat in many international conferences, saninars and study groups has been considerable during the period under review. W P/RC 7/3 Page :2 The principle of integration of specialized activities into the general public-health structure of a countr.y, although generally accepted, cannot be implemented until preliminary improvement has taken place in a country1s public-health organization, thus permitting the establishment of long-term national planning. Assistance in the planning and implementation of integration in countries and territories which are prepared for this step has, however, been given whenever requested. The difficulties surrounding this aspect of the work are outlined in Part II, page 16 of the report. Activities in fields of interest to which particular attention has been drawn by the Execut ive Board andv~orld Health Assemblies have been encouraged. The exchange of information and the stimulation of activities in many of these new fields have been intensified. Thus, environmental sanitation programmes in many Member Countries and territories have been given considerable impetus by the holding of a Water Standards Stuqy Group in which experts from various countries and territories in the Western Pacific and South-East Asia Regions participated. The implementation of a zonal seminar on the utilization of organic wastes to be held in Chir~ in October of this year is another regional project that is expected to focus attention on this type of public- health activity. Mental health continued to recei VB the emphasis that had been given it in previous years, with awards of fellowships to an increasing number of health personnel, as well as the giving of consultant services in this field to countries within the Region. An introduction to the nursing aspects of mental health has started with the recruitment of a consultant on mental nursing whose services have been made available to a number of countries. A fellowship on the peaceful use of atomic energy has been approved and placement is being awaited, and there are indications of a growing interest in this particular field in many countries in this area. Apart from the changes brough t about by newer developments in the prevention and control of the various diseases l1l3ntioned above, and the initiation of new programmes on a limited scale, there have been no major trends which would affect the development of the regional programme as planned. It is evident, however, that as the public-health structures of the countries are improved and more and more health personnel are trained to give these support, integration or consolidation will be facilitated and increasing new demands for assistance, advisory or otherwise, on the Organization and the various agencies with whom the Organization collaborates, may be expected. In what form and to what extent this would be is difficult to predict at this stage. :2 THE REGIONAL COMMITTEE The sixth session of the Regional Committee was held at the University of Malaya, Singapore, from 13 to 19 September 1955. The meeting was attended by representatives of all Member States in the Region, including the Govern- ments of France, the Netherlands, Portugal, the United Kingdom of Great Britain and Northern Ireland, and the United States of America, who are responsible for territories in the Region. Representatives of the United WP!RC7!3 Page 3 Nations (including UNICEF and the Technical Assistance Board) and FAO, and of eight non-governmental organizations in official relations with WHO, were also present. The Director-General attended. The Committee nominated Dr. I.C. Fang for reappointment as Regional Director for the period 1 July 1956 to 30 June 1961. The question of more permanent accommodation for the Regional Office was discussed and the Regional Director was requested to continue negotiations with the host GovernlOOnt and to keep the Regional Committee infonned. A sub-committee was set up to make a detailed study of the proposed programme and. budget for 1957 and to advise whether the different kinds of assistance proposed were suitable balanced. The advantages to be derived from the appointment of area representatives were again endorsed. The relation between the regular and Technical Assistance programmes was discussed in some detail and the effect that the new procedure for financing projects from Technical Assis tance funds would have on programme construction was explained. The report of the sub-committee was considered by the Regional Committee in plenary session. The Regional Committee approved criteria to be followed in selecting the projects which should be financed from regular fUnds and asked the Regional Director to keep this question under review. A supplementary list of projects was reviewed and endorsed. The Regional Committee adopted a resolution requesting Member States to speed up their plans for malaria control so that malaria might be eradicated and the regular insecticide-spraying campaigns safely terminated before the vector anophelines developed an effective resistance to insecticides. The importance of intra- and inter-regional co-ordination of malaria campaigns was stressed. The Regional Committee noted that a Malaria Eradication Special Account had been set up and the representatives of China and Japan stated that their Governments would donate to the Account supplies and equipment for malaria control. The Regional Committee approved a general programme of work for the years 1957-1960. It also approved the Annual Report of the Regional Director and commended the increased attention given to projects operating in two or more countries. It emphasized the importance of exchanging infonnation between countries, and of circulating among Members the reports of Member States on specific projects and, subject to the agreement of the countr,y visited, th:e reports of experts who visited countries in the Region. It was recognized that WHO-assisted field projects could make a full and lasting contribution to the strengthening of national health services only if the method of integrating them into the permanent health services was properly planned. The Committee urged Member States to make adequate plans for integration and requested the Regional Director to provide any necessary assistance. WP/RC7/3 Page 4 Too subject of the technical discussion was "Domiciliary midwifery as an approach to the people in the development of rural health services". The Committee divided into three small groups for this discussion, in which the most prominent topics were: (a) the place of domiciliary midwifery in the development of rural-health services; (b) the difficulties arising from lack of trained personnel to provide rural midwifery services; (c) the scope and limi tations of the midwife IS fune tions and the kind. of training needed; (d) the conflict between traditional customs and modern obstetric practice, ·and. (e) the relative merits of domiciliar,y midwifery and hospital obstetric services in IIdevelopedll countries. The consensus of opinion was that an organized domiciliary midwifery service was an important part of any rural-health programme, although it did not necessarily facilitate the introduction or development of other services. The Regional Committee decided to hold its seventh session in Manila in 1956, and accepted the invitation of the Government of the United Kingdom of Great Britain and Northern Ireland and of the Governor of Hong Kong to hold the eighth session in Hong Kong in 1957. 3 REGIONAL OFFICE 3.1 General By the end of August 1956 the Western Pacific Region will have been in existence for six years. The Temporary Office was situa ted in Hong Kong for exactly one year. At the first session of the Regional Committee, it was decided to accept the invitation from the Philippine Government and the Regional Office was formally established in Manila on 1 September 1951. The day-to-day working relationship between the Govern- ment of the Republic of the Philippines, and its various offices, and the Regional Office continued to be ver,y satisfactory. During the period under review it was decided that the time had come for a critical review of our technical and administrative procedures, as with the gradual expansion of work over the years methods had been developed to suit certain conditions, while fun::;tions originally assigned to one unit had gradually proved to be of major interest to other units. It was also felt that there was a need for more detailed delegation of authority, and. that the various ad hoc and other more permanent arrangements should be reviewed with a view to-draWing up more formal procedures, taking into account present needs and foreseeable requirements. The fact that various units had requested additional staff was also taken into consideration as it was felt that the present working pattern should be carefully studied before any change was made in the staffing pattern. The Regional Director requested, therefore, the assistance of the Manage- ment Section at Headquarters and the Chief of the Section came to the Region for slightly over two months at the end. of 1955. He worked closely with technical and administrative staff and it proved to be a most fruitful co-operation which resulted in: WP/RC7/3· Page 5 (a) pin-pointing of individual and rectional responsibilities and terms of reference; (b) the establishment of a series of regional handbook circulars in which working procedures are laid down; (c) the procuremmt of labour-saving devices, such as dictaphones, postage and addressing machines, photocopying equipment; and (d) a complete revision of the handling of outgoing and incoming communications. It proved possible through these rreasures to adhere to the approved staffing pattern. Continuous thought is h::ing given to a more effective approach to working problems, as they occur, in '3.n attemrt to solvJ them in a manner which dOGS not necGssit2te an incroas8 in staff. 3.2 Accommodation Previous reports submitted to the Regional Committee have emphasized the inadequacy of the present accommodation. Details with regard to the possibility of establishing a permanent office are contained in a document prepared for this session of the Committee. It is, therefore, unnecessary to report further on the question of accommodation at this point apart from stating that it is apparent that delay in erecting a building will create operational problems in the years to come unless, as a temporary solution, additional space is put at our disposal. 3.3 Organizational structure and area representatives No change has been made, or is proposed, in the approved organizational pattern for the Regional Office. A third public-health administrator will be seconded to the Regional Office and can be expected during the last half of 1956. The purpose of his secondment is to develop and co-ordinate activities financed by Technical Assistance funds and expenses connected with his assignment will, therefore, be rret from this source. Following consultations between the Department of Central Technical Services at Headquarters and the Regional Director, the Director- Gereral has approved a proposal tmt the Regional Office takes over th3 Epidemiological Intelligence Station in Singapore, although the Station will continue to serve the same area as in the past. The budget estimates for 1957 and 1958 include, therefore, provision for this activity for which a corresponding transfer of funis to the Region will be made by Headquarters. This cEvelopment, to be completed by the 1 January 1957, is beneficiaJ. to the Region due to tho Medical Officer In-C~rge of the StQtion t~king o~er the func- tions of area representative for Drunci, the Federation of f:Ialaya, Uorth Borneo, WP/RC7/3 Page 6 Sarawak ani Singapore in addition to former tasks.. As this arrangement became effective in May 1956 one additional area representative is now being provided without additional expenses for salary, local staff and office up-keep, Our expenses are limited to a small amount for duty travel and minor expenses directly associated with the regional activities which will be more than offset by a reduction in duty travel for other regional office staff. The post for Cambodia, Laos and Viet Nam was filled early in 1956 and the representative assumed his duties in March after a short period of orientation in Manila. A third representative for the southern part of the Region reported for duty in Manila on the 15 June. He will, on completion of his orientation period, take up his dutie s in Sydney before the Regional Committee Meeting begins. 3.4 Regional Office staff The assignments of two of the Regional Advisers, one in Maternal and Child Health and the other in Education and Training, were completed in the last half of 1955 as the ir periods of leave from their respective govern- ments had expired. The former post was not filled until April when the acting Chief of the Maternal ani Child Health Section at Headquarters was transferred to the Region. The latter post has been filled by a candidate from Japan, who will report for duty on 1 August 1956. This will improve the geographical distribution of international staff in that it' brings tl:e number of countries represented up to 10 among 22 positions filled. As of 30 June 1956 one vacancy remained unfilled, that of Regional Statistician and Project Evaluator, but a suitable candidate has been found and it is hoped that recruitment may be completed during July. The post of assistant translator, which had remained vacant for nearly a year, was finally covered as of 1 June through the transfer of a staff member from Headquarters. In the year under review the turnover of local staff has been limited to one who resigned for personal reasons and who has been replaced. In addition, one new post was filled by a national of Viet Nam to assist the area representative. Thirty of the 47 local staff members, including custodial staff, have been with us for more than four years, 37 were recruited before 1 January 1954 and only 'bwo have been with us for less than 18 months. The advantages of having a trained staff, able to take over additional and more complex duties, were again marked during the management survey. mentioned above, as it otherwise would have been impossible to deal with the increased activities without more staff. In several cases more senior local positions have been filled through promotions and it has been possible on three occasions to use locally- recruited staff as administrative support for seminars and other conferences held aw~ from Manila. 3.5 Project staff WP/RC7/3 Page 7 It is natural that changes in project staff remain high in comparison. Consultants are recruited for short periods, normally three months or less, while the completion of project activities and implementation of other projects in different fields, combined with the accepted principle of using in one region well-qualified staff who have shown ability, techni- cally and in co-operation with government counterparts, in other re&ions, are among the reasons for this. On 1 July 1955 there were in the Region 62 project staff, including six consultants, employed on 33 different projects. The comparative figure on the 30 June 1956 was 60, including eight consultants, on 33 projects. During the year, 19 consultants were recruited and 17 terminated, 19 project staff reported for duty through recruitment, or transfer, and 22 completed their assignments; nine of these were transferred to other WHO activities outside the Region and one was promoted within the Region to area representati vee Annexes I-IV give details of staff employed in the Regional Office and in the field, including geographical distribution. 3.6 Other personnel matters During 1955 the Philippine Government, assisted by a firm of consultants, completed a thorough survey of employment practices in the country, the purpose being to assess what changes might be required in its civil service.· When the report was published, the Regional Office used it as a guide in a review of the local salary scale established shortly after the move to Manila; excellent co-operation was also obtained from government offices, foreign missions and commercial undertakings. It was found that our local salary scale was in general in keeping with the best prevailing practice in Manila, but that minor modifications ought to be made. The results of the review are being studied at Headquarters but it can already be stated that whatever modifications are decided upon will not involve the Organization in additional expenses. In several countries in the Region the cost of living has gom up. This has necessitated continuous attention to allowances applicable to project staff for travel within the countr,y, and particularly in connection with housing, which is becoming increasingly more difficult to find, and which on the open market in many areas fetches exorbitant rents. It is apparent that a satisfactcry solution to trese problems can only be found through close co-operation with the governments even if they are not required to meet the cost of lodging on projects financed by regular funds. In one country the problem has been alleviated by the Qovernnent establishing a preferential exchange rate for diplomatiC and United Nations personnel. WP/RC7/3 Page B 3.7 Project activities It proved possible during the last half of 1955 to implement a number of requests, mostly for fellowships, which had initially had to be included in the supplementary programme. As a result the allocation of regular funds was committed 100% befere the end of the year. Headquarters assisted the Region further by making available savings accruing in other regions under the Technical Assistance programme to an amount of $50,000 which was committed to such an extent that only 1-1/2% of our increased allocation remained when our accounts were closed. This enabled a number of Category II activities, or other supplementary requests, to be lifted to Category I. Since our 1956 allocation of Technical Assistance funds is limited to the approved Category I activities, every attempt has been, and is being, made to implement this year I s Category II projects as, and when, savings accrue within the country concerned, or within the Region as a whole. Further continuous attention is being given to the use of some non-convertible currencies due to the requirement that unless certain minimum amounts are used far approved activities, our allocation will be correspondingly reduced. It now appears that we will succeed in mesting this requirement and we may even be able to use more, thereby assisting other regions to meet their targets. 4 AGREEMENTS WITH GOVERIDENTS Nineteen agreements relating to plans of operation for projects were signed during the period urrler review. Six of thase conc'srned projects for which assistance in the form of equipment and supplies is being given by UNICEF. A list of the agreements is contained in Annex V. 5 CO-OPERATION WITH THE UNITED NATIONS AND OTHER AGENCIES The implementation of a large number of pro jects in the Region in such a manner as to ensure their ultimate success would not have been possible without the collaboration of many international, bilateral, or other agencies operating in the countries of this area. Certain difficulties, however, do arise in assuring co-ordination with other health activities, particularly those in which other foreign aid organizations are concerned. It would be a distinct step forward if governments would actively take the lead in this matter and distribute the information available. 5.1 With the United Nations Developments in the schistosomiasis project in Leyte have pointed to the need of an overall community development programme in the bonification of land. The assistance of the Community Development Expert in the Philippines was therefore enlisted to initiate a community develop- ment programme in an endemic area in which the project staff would advise the people on methods of control to be initiated by themselves. The United Nations expert has been co-operating freely in this project and although WP/RC7/3 Page 9 the a.ctual amount of success in field development is still snail, there are signs that progress will improve. Further co-operation in this work has been received from the Social Studies Research Unit in the University of the Philippines and from'a social anthropologist working in the Philippines under the Fulbright scheme. 5.2 With other United Nations Agencies 5.2.1 UNICEF As in previous years, co-operation has been maintained with other United Nations agencies in the area. Close liaison with UNICEF, through its Regional Office in Bangkok, and its country representatives in the Region us continued. Assistance in pI arming and technical approval and technical guidance have been given to UNICEF-assisted projects so as to ensure as wise an expenditure of resotn'ces as possible, and as effective a project as could result from the canbined assistance. Programmes in the fields of comrnunicable-disease control, maternal and child health, a.n:i trachoma have benefitted most from UNICEF assistance ani the total number of projects in the Region now receiving aid in the form of equipment ani supplies is 29. The Area Representative in Cambodia, Laos ani Viet Nam is also honorary representative for UNICEF in the area and this joint appointment has many advantages. In Part III will be found details of the different types of programmes receiving supplies and equipment from UNICEF and advisory services from WHO. In addition, during the period urxier review, UNICEF has assisted the following prograITlIOO s in which WHO has given technical advice am guidance: China 9 .. Triple va.ccination, China 10 - BCG vaccination, Federation of Malaya 9 .. Yaws control, Japan 1 - Rehabilitation of Crippled Children, Korea 9 .. Midwifery training, letrerlands New Guinea a - lfalaria control, Netherlands New Guinea 3 .. TB/BCG, Netherlands New Guinea 4 - Yaws, Netherlands New Guinea 6 - Maternal and child welfare, Philippines 15 - Treponematoses control, Philippines 17 .. BCG vaccination, Philippines 26 .. Drugs and· diet supplement, Philippines 40 - ItJH Services and Training Progranme, and Philippines 49 - Leprosy control. Technical Assistance Programme There has never been more reed for close co-operation a.r:rl co-ordination of work with the repre sent ati ves of this United Nations agency than at present, as the introduction of a new procedure in the planning of Technical Assistance projects has confused a number of countries and territories. During the period under review, however, close collabora- tion with the Member States, the Regional Representative of the Technical Assistance Board and WHO has resulted in improved programme co-ord1nation and a clearer understanding of the Technical Assistance programme as a whole. WP/RC7/3 Page 10 5.2.3 FAO The Regional Office collaborated with FAO in a Nutrition Education and Health Education Seminar, which was held in Baguio at the end of 1955. The holding of this inter-regional seminar was the cUlmination of almost two years of close co-operation between FAO and the Organization. Since the seminar was held in this region the Regional Office carried the major responsibility for its organization but throughout the preparatory period close liaison was maintained with the South-East Asia Regional Office, Headquarters, and the FAO Headquarters. Joint planning meeting s of represen- tatives from the two organizations were held in Rome, New Delhi and Manila and a team composed of an education officer from each organization visited the majority of the countries and territories participating in the seminar in advance of this meeting. Certain facilities of this office are also being made available to'FAO in a conference which is scheduled to be held in the autumn of this year. 5.2.4 UNESCO In Cambodia, UNESCO is assisting the Government in a fundamental education (and community development) project. Although it was not possible for WHO to assign a medical officer full-time to this project as suggested by the UNESCO team leader, WHO field personnel in Cambodia have co-operated as much as their other responsibilities and duties permit, by visiting the fundamental education project regularly, in company with their national counterparts, to renier medical assistance an:! to give instruction in health education and first-aid. Some of the trainees on this UNESCO-assisted project have attended short training courses in health education organized by the United States International Co-operation Administration (ICA) mission in Cambodia with the assistance of WHO field personnel. The UNESCO-assisted fundamental education project has been expan:!ed and its activities extended to Tahkmau. The rural-health demonstration and training centre in Cambodia is to be located in Tahkmau and the centre building is under construction. With the WHO appoinbnent of an international medical officer for rural health soon, it is anticipated that closer collaboration between UNESCO and WHO will be obtained. In fact in Tahkmau there will be a multipurpose rural project. 5.2.5 Other Specialized Agencies In agreemm t with the Regional Office for South-East Asia, observers have been sent to conferences organized by the Economic Commission for Asia and the Far East. In Korea, close liaison has been maintained with the representatives of UNKRA. 5.3 With bilateral agencies WP/RC7/3 Page 11 The Regional Office has also maintained harmonious relationship and close collaboration with the United States International Co-operation Administration (ICA) officials in Cambodia, China, Korea, Laos, the Philip- pines and Viet Nam in the implementation and co-ordination of international health activities in these countries. Assistance in the form of eqUipment and supplies has been given by ICA to a number of WHO-assisted projects; this support has greatly facilitated the progress made, particularly in the earlier activation of malaria-control projects. The Cffice has also collaborated with the Rockefeller Foundation and the French Economic Aid in cormection with the latter1s activities in Cambodia. The Area Representative in Saigon also maintains close contact with the representatives·of the British Commonwealth countries regarding Colombo Plan assistance. 5.4· With non-governmental organizations The Regional Office has sent observers to the Third Conference on Health Education held in Manila during August 1955; the Asian-Pacific Tuberculosis Conference held in Sydney from 15-21 August 1955; the Far East Conference on Work for the Blind held in Tokyo from 19-26 October 1955; the South-East Asia Regional Meeting of the International Women I s Medical Association held in Manila from 28 January to 3 February 1956; and the Asian Confederation of Medical Associations and First Cardiological Congress of Asia and Oceania held in Manila from 17-21 April 1956. 5.5 South Pacific Commission During the year under review, active steps were taken to lay down the machinery for effective co-operation between the Regional Office and the Commission. Direct conversations were possible during the Third South Pacific Conference held in Suva, 23 April to 3 May 1956. As a result, it has now been possible to define accurately the procedures for the use of Technical. Assistance funds in the development of joint projects. As will be seen in the proposed progra.m.roo and budget, negotiations for two projects in health education and filariasis are in progress. 6 NATIONAL PUBLIC-HEAIl'H PROGRAJ.ME CO-ORDINATION COMMIT'lEES 6.1 China Tha Co-ordination Committee on Foreign Aid in Medicim and Health in Taiwan, Chioa., continues to meet regularly once a week and to function most effectively. The success of the WHQ-assisted projects in Taiwan is in no small measure due to the work of the Cormnittee in determining what WP/RC7/3 Page 12 assistance too provincial health services require, the part the various outside agencies can play and in minimizing ov~rlapping or duplication of effort. 6.2 Philippines The Public-Health Programme Co-ordination Committee in too Philippines was initiated in 1951, through the incentive of WHO, as a co-ordinating body for national and international agencies interested and engaged in public~health work in the Philippines. There have been forty-nine (49) regular and special meetings held during the period of its existence, with representation by the Department of Health of the Philippines, the National Economic Council of the Philippines, UNICEF, WHO, the United States International Co-operation Administration (ICA), the Resident Technical Assistance Representative to the Philippims and the Social Welfare Administration of the Philippines. The Committee has been successful in co-ordinating activities of the various agencies, so that no significant overlapping or duplication of programmes has been brought to their attention during the current yaar. Information is freely exchanged and joint planning is encouraged. The ten sub-committees of too Co-ordination Committee have functioned actively during the period under review in co-ordinating activities within specialized fields of endeavour in public health. The addi tion of staff members of the Institute of Hygiene of the University of the Philippines to the sub-co~~ttees has been successful in drawing these public-health educators into the operating sphere in the Philippine public- health programme. A fellowship study group composed of representatives from the Department of Health, the Resident Technical Assistance Representative, ICA and WHO prepared a report and recommendations on fellowship procedures to be followed by the Government, the Technical Assistance Board, ICA and WHO. 7 PUBLIC INFORMATION 7.1 General During too period under review, the Public Information Office continued to intensify its efforts to achieve its two main objectives: (1) to tell the story of WHO in general, and of the work in too Western Pacific Region in particular, to the peoples of the countries in the Region; and (2) to gather for the Division of Public Information at Headquarters, and the Department of Public Information of the United Nations, material on WHO work in this region which can be used. by them to tell the people of too world of the work of WHO. WP/RC7/3 Page 13 In this connection, greater co~operation has been developed with government liaison officers who have the responsibility of promoting and co-ordinating public-information activities on WHO. This has resulted in a more effective dissemination, and in many instances, a wider production of information material on WHO in many countries. In addition, steps taken to get WHO persormel in the various WHO- assisted health projects to produce rna. terial whic h could be used for public information purposes have also met with considerable success. Before the end of 1955, a selection of articles which tell in human terms of the progress being made in the improvement of the health of the peoples in the Region was compiled into a booklet entitled "Stories of the World Health Organization in the Western Pacific". Copies have since then been widely dis tributed and its usefulness as a source of information and of sI=8cial features for the press is evidenced by continuing requests for the booklet. A special issue of the WHO Newsletter featuring the work of the Organization in the Western Pacific was also published early in the year. This publication was well received and in the United States Senate, special mention was made of the work of WHO in the Western Pacific. 7.2 Exhibits Photo sets, entitled "Health is a Fundamental Human Right", can- posed of twelve panels, which were prepared at Headquarters, were distributed to the various health administrations in the Region and have been widely used for occasions such as World Health Day and United Nations Day to illustrate progress in international health work. Assistance was given to WHO exhibits set up at the International Exhibition in Phnom-Penh, Cambodia, United Nations Week in the Philippines, Health Week in the Federation of Malaya and in con- nection with the Regional Committee Meeting held in Singapore. 7.3 World Health Day As in previous years, this was again successfully observed in the Region, with each country commemorating it on a truly nation-wide scale. Celebrations which used to be limited only to metropolitan areas have been extended to the rural areas. How extensive World Health Day celebrations have become is indicated by reports received from Australia, Cambodia, Fiji, French Oceania, Hong Kong, Japan, Korea, Netherlands New Guinea, Singapore and Viet Nam. In AUstralia, a report from one of the branches of the United Nations Association of Australia stated that its "..rHO Standing COIl1llittee successfully focussed public attention on the theme of World Health Day. In Cambodia, the press, radio, and movies were utilized to bring the message of World Health Day to all the people. WP/RC?/3 Page 14 In Fiji, special publicity materials in Fijian, Hindu and English were widely distributed throughout the island. In French Oceania, the radio was used to reach the people through the broadcast of messages in both French and Tahitian languages. In Hong Kong, World Health Day was celebrated with much enthusiasm and the start of a vigorous campaign to eradicate insects coincided with World Health Day. In Japan, the Ministry of Health and the United Nations Association of Japan, and civic organizations such as the Society of the New Life Movement and the Health and Hygiene Association, collaborated in the organization of World Health Day. There were varied programmes throughout the country. To publicize the occasion, 100 000 posters and 100 000 leaflets were prepared and distributed, a radio programme that reached an estimated number of 30 million listeners was broadcast and special articles in newspapers, magazines and other periodicals appeared during the celebration. A demonstration and a well-attended rally was also held in Tokyo. In Korea, an ad hoc World Health D~ committee composed of a comprehensive list of officials was organized and ensured the successful observance of the occasion. In Netherlands New GUinea, special supplements were issued in the local Dutch and Malay papers. The Education Department and the Mission Schools co-operated to bring the message of World Health Day to all the schools and from the schools to all the population. In Singapore, an exhibition was prepared featuring the theme of World Health Day. Film shows were organized in many parts of the city for a week, pamphlets and posters were widely distri buted to schools and other public institutions, and radio talks by health authorities were broadcast. In Viet Nam, the President of the Republic led the nation in the observance of World Health Day. In addition to an impressive programme, an exhibition of international health work was arranged and film shows were also given in many parts of the country. WHO assisted by distributing over 17 000 units of information material in English, French and Portuguese. World Health Day material was also translated into Chinese for distribution to the large Chinese population in the Region. The active co-operation of the various United Nations Associations should be noted as this contributed greatly to the success of this year1s World Health Day. 7.4 Other publicity During the year, 101 press releases, press notes and special features were issued, and a total of 23 000 copies were sent to approximately wPjRC7/3 Page 15 200 outlets in the Region. A limited mailing list of editors and press correspondents was also compiled for the "Health Front" which is a monthly publication by WHO Headquarters, designed primarily for reproduction as features in newspapers and magazines. The acquisition of a new tape recorder from Headquarters has made it possible to increase the radio material gathered from the Region, Over 50 tape recordings, with an average length of from five to seven minutes each, were made and passed on to the Divi sion of Public Information, Headquarters, the United Nations Division of Public Information, New York and also to radio stations in the Region. During the period under review, over 800 photographs dealing with the various activities of WHO in the Region were taken and forwarded to Head- quarters. Three conferences were covered during the year, the second WHO Nursing Education Seminar held in Fiji in July 1955, the FAO/WHO Health Edooation and Nutrition Seminar in Baguio in November 1955 and the WHO Water Standards Study Group in Manila in April 1956, in addition to the sixth session of the Regional Committee in Singapore. WP/RC?/3 Page 16 PART II - GENERAL STATEMENT OF'ACTIVITIES IN THE REGION 1 PUBLIC-HEALTH SERVICES 1.1 Assistance to governments in the developing and strengthening of their health services In writing on this subject, it is easy to prepare a statement which would be platitudinous and easy to accept, and which would, in its generalization, conceal situations which prevent the fulfilment of the resolutions which have been adopted urging the Organization to assist governments in developing and strengthening their health servic es by the integration of fi eld pro jects in th eir long-term planning. The first difficulty facing the Organization is to obtain from many governments detailed repor~ of their public-health planning, indeed requests to obtain such information are not always acceptable, and are sometime~ regarded as an unwanted burden by busy administrator s. This difficulty is aggravated by the limited duration of the stay of advisers and public-health administrators during their visits. Influencing the rigidity of these timetables is a desire to avoid criticism of overstaying onels welcome and burdening busy administrators, yet on occasions the complaint is made that the stay is not long enough to be able to make a true assessment of the state of the public-health administration. In this respect, attention is drawn to the appendix on travel (Annex VI). A discussion on this topic by the Regional Committee in session might help to solve what is a perplexing dilemma. In respect of this problem, it would be of some help if, during the visit of members of the Secretariat, invitations were extended to attend conferences occurring during the visit. An example of this was an invitation issued to a public-health administrator to attend a three-day annual conference of State Medical and Health Officers in the Federation of Malaya, where the administrative and technical problems of the year were under discussion. The courtesy and confidence which prompted the invitation is much appreciated and such occasions give an outstanding opportunity to learn of the problems and to assist in their solution. Indeed, it might be worth considering if countries would extend invitations for special attendance at such meetings. Attendance could be well planned to allow other duties to be performed during the visit. The appointment of area representatives will undoubtedly halp to solve this problem. Another difficulty is the failure of many governments genuinely to understand the philosophy of WHO assistance. Too often, WHO project personnel are regarded as extra hands in the daily work programme of the public-health service and not as teachers developing new, or improving WP/RC7/3 Page 17 old, services. There is very often little attention paid to the selection of counterparts, or if selected, to their continuance in the posts for which they are specially trained, they do not always have a suitable background and in sane instances their importance is not fully recognized by the national health administrators, which makes it difficult for them to carryon the work when the international staff is withdrawn. Again, in the selection of candi- dates for WHO fellowships for counterparts, there is I regret to say, often exclusion of the WHO experts from advising in the selection. More basic in difficulty is the inability of countries to make long-term plans in the face of insufficient funds or the uncertainty of a steadily expanding budget. Too often it is only possible to tackle inmediate urgent problems in the face of shortage of funds and personnel, as a result of restrictions placed on the government o,rganizational structure and the staffing pattern. These points are stressed to emphasize that while the objective of WHO is to assist long-term planning the difficulties should not 'be overlooked. The real obstacle, however, is the inability of countries with inadequate staff to meet the burden of integrating mass campaigns against specific diseases of public-health importance into their rural-health seMioes. Too often the story is no staff, no money. It is surely time to be realistic and evaluate the situation, to set a limit to the pressures which international assistance may have caused and turn assistance to the development of training schools for personnel at all levels sufficient to meet the general demand., while supporting health departments to obtain a larger share of the national budget. Outstanding in the field of strengthening of public-health services during the year has been the development of the rural-health training centre in Jitra, Kedah, Federation of Malaya, the strengthening of the , Central Medical School, Suva; Fiji, the decentralization of medical and health personnel in the rural areas of the Philippines, the planning of communit,y development schemes of land improvement to control schistosomiasis in the Philippines, and the development of long-range plans for environmental sanitation both in China and the ~lippines. In Cambodia, the Ecole des Officiers de Sante has, been upgradi3d and in order to attract students, WHO is financing a number of fellowships each year so that government funds can be used to finance a smaller number of scholarships at a higher rate. Assistance has also been given to the School far Health Technicians in Viet Nam, the graduates of which will fill a great need in the rural areas where there are at present no medical or health personnel of any kind. In the overall picture, however, the greatest benefit will arise from the assistance to education and training in IOOdical schools, post-graduate schools of public health ani in the training of nurses and health inspectors. WP/RC7/3 Page 18 Of importance also is the establishment of effective working procedures with the South Pacific Commission in the integration of project activities in the South Pacific area. In the epidemiological field, the making available of highly skilled experts through Regional Poliomyelitis Centres must strengthen the heal th services of the Region in this important field. During the year, visits of consultants in various fields such as dental health, mental health, environmental sanitation, trachoma, psychiatric nursing, public-health nursing, almoner training and medical education-pro- vided Governnents with expert knowledge On which to build new services. Much can be done of basic importance to the public-health services of the Region which would involve the governments in relatively small expendi~ tures. It is just as important that the maximum should be extracted from existing services as it is that new services should be started. The Organiza- tion is already giving assis tance in work of this kind, for example in statistical work, in epidemiology, in aid to teaching institutions and in hospital administration. Details of the different types of assistance given to governments during the period under review will be found in subsequent pages. 1.2 11aternal and Child Health Evidence of interest and concern with the particular health needs of mothers and children is found throughout the Region. In a number of countries, including China, Hong Kong, Japan and the Philippines, considerable progress has been made in establishing or extending preventive maternal and child health services in local health stations or dispensaries, frequently with WHO and UNICEF assistance. In Cambodia and Viet Nam, much has been achieved in improving the facilities for care and treatment of sick children. The comprehensive child health service at the new Children1s Hospital in Saigon is of particular interest, and is an encouraging development in linking the preventive and curative services more closely. _In addition to providing treatment, regular sessions have been arranged for child health consultations and follow-up visiting in the homes within a limited area is to be started shortly. The hospital will be used as a centre far teaching and research. Shortage of well-trained staff remains one of the most serious handicaps to the development of maternal and child health programmes. It is noticeable in the field of administration, as well as in the qualit,y and extent of the services provided. Maternal and child health services often appear to be established on a set- pattern without a real assessment of the specific local needs arrl the order of priority in which various health problems affecting mothers and children -should be tackled with the WP/RC7/3 Page 19 resources available. In many areas, there is still a need far more factual information as a basis for programme planning, for eValuation and for the development of training programmes. It is encouraging to note the attention given to maternal and child health in the curricula of basic and post-basic training programmes for nurses and midwives in a number of countries. Although in-service training of doctors and other staff doing this work is provided in a few countries, it is generally true to say that the training of madical students and doctors in maternal and child health is still relatively weak, particularly in the field of paediatrics. In China. and Korea, the refresher training courses for private practising midwives sponsored by the Governments and assisted by WHO and UNICEF have had an excellent response and should make a valuable contribution , to improving the standard of maternity care, as well as promoting better understanding and co-operation between private practitioners and government staff. Assistance has continued to the programme of training of traditional birth attendants in the Philippines. There are indications that this is leading to better prenatal supervision, but as yet, it has not been possible to assess the results of the prograrnroo in detail. Special progranmes for premature infant care and for physically handicapped children have been established in several countries in the Region. WHO has provided technical advice and fellowships to assist this work in Japan and the Philippire s. School-heal th prograJllTle s have made some encouraging progress during the year. In Cambodia the health and education department staff are working together in the demonstration health'service far urban schools, and the teacher-training programme in Phnom-Penh. A small rural school-health demonstration project is to be started shortJ.y, and the services will be extended throughout the provinces. This programme is being assisted by WHO, UNICEF and by ICA. In Hong Kong, where a sohool-health programme was included in the WHO/UNICEF assisted maternal and child health project, the interest and co-operation of parents and teachers in the schools used for a demonstration programme have been remarkable. A school-health education progranme is now well established, and the services are being extended to other schools. In a general review of the organized child health services in the Region, it is noticeable that those for help in the care of infants are ,the best developed, while health services for children attending school appear to be given the :tExt priority. The difficulties of reaching and maintainiDg contact with the pre-school age group (1-6 years) are recognized, but this period of a child I s life is of such critical importance that ways of providing continuing health supervision between infancy ani the age of atterrling school are matters which deserve urgent consideration. WP/RC7/3 Page 20 / 1.3 Nursing The main objective of the nursing projects in the Region is improvement of nursing and midwifery services through education. Hence programmes are concerned with (a) development of curricula for basic nursing or midwifery education which are based on local reeds, (b) preparation of counterpart personnel for teaching responsibilities, (c) improving facilities for the practical experience of students and placing greater emphasis on clinical instruction and (d) improvelOOnt of the quality of nursing practice through refresmr courses, in-service training or post-graduate courses for qualified nurses and midwives. Although there have been notable achievements in some countries, one of the most difficult tasks is to evolve an educational programme which is suited to the educational level and background of students and prepares them for the kind of nursing which their country requires. Forejgn practices often strongly influence both international workers and returned fellows and legally established requirements frequently impede change even when the need is recognized. It is encouraging to observe in a number of countrie s, a greater awareness of the value of assigning local counterparts to work with WHO personnel and a stronger tendency to plan for replacement of international workers by national nursing staff, with a gradual shifting of responsibility as counterparts are ready to assume it. However, in countries which are endeavouring to elevate nursing from a sub-professional level there is still a shortage of nurses who are ready for preparation for positions of leader- ship. In others, the capacity of local nurses for leadership may be some- what underrated. There is a growing appreciation of the need for nurses to learn nursing where it is practised and hence more attention is being paid to the clinical supervision of students and provision of domiciliary experience for student midwives. Many eli fHcul tie s in this area still have to be surmounted, the main ones being the need for closer co-operation between teaching and service personnel, for greater stability and better preparation o{ staff members, and, in the case of domiciliary midwifery, for the budget, facilities and personnel necessary for providing a service. In all the countries visited by the Nursing Adviser, some form of education programme for practising nurses or midwives is operating or planned, either with or without WHO assistance. Requests were received from three governments for WHO to provide an instructor in psychiatric nursing or mental health in 1956. In another country, the nurses have expressed a desire for assistance of this kind. A psychiatric nursing consultant has been made available to advise on programmes for these four countries. WP/RC7/3 Page 21 Evidence has been received from many sources that the Nursing Education Seminar held in Fiji in 1955 has had far reaching effects. Not only do participants testify to its value in relation to their own work but many otffirs have also been influenced by their experience. At least four countries have held nursing workshops led by saninar participants. ,t: ,~ f".: 1.4 Environmental Sanitation The problems of environmEntal sanitation continue to 00 of major concern to countries of the Region. The recognition that a large proportion of the diseases and conditions existing in these countries are attributable to faulty envirorwant, has led the health services of the countries to seek both te~ary and permanent solutions to these problems. The major emphasis laid on these problems in most of the countries has been for the provision of a safe water supply and sanitar,y disposal of human excreta. The recognition of the ne ed for, and improvemant of, pro- grannnes for food sanitation has also been evident. This interest has been stimulated to a large extent by the dissemination of technical information through WHO aIXi the various seminars and stuctr groups convened by the Organization •. Of special interest are the efforts by Member Countriee to introduce water-borne sewerage systems in those communities which, until now, have been either entirely without such facilities or servedby household latrines and communal nightsoil collection systems. In China, consultatiV' services have been provided for the planning of municipal water-borne seweI ~ system. . "-In North Borneo, problems relating to the design of small sewerage systems and treatment works fer tropi0sl countries have been successfully solved and standard designs which should be useful throughout the Region have been produced. The economic feasibility of the installation of water-bame sewerage in this type of community has been successfully demonstrated. There is also a widespread interest throughout the Region in the possibility of the utilization of organic wastes for agricultural uses. This is reflected in the subject for the WHO Zonal Environmental Sanitation Seminar to be held in Taiwan late· in 1956 entitled "Collection, Disposal and Utilization of Organic Wastes." In Japan, the Government, in co-operation with the City of Kobe and with the assistance of WHO, has initiated a programme to study the possibility of camposting of nightsoil and municipal organic refuse for the production of a finished product suitable for agricultural utilization. Pilot plant operations have been successfully carried out over a period of approximately one year, and a full-scale prototype camposting plant designed on the basis of the experience gained in the pilot ~roject is now in operation. Studies will be continued on the full-Bcale camposting plant with the expert advice and consultation of a WHO publiC health engineering consultant, who visits Japan periodically for consultation services. WP/RC?/3 Page 22 Widespread interest in the project has been evinced by many technicians in countries in' the; RcCiG:.1, ::.:1d it j.s expected tr-".'lt if this plant proves to be feasible and economical it will have a profound influence upon the course of sanitation history in Asia. New techniques, such as the membrane filter method for the bacteriological examination of water, have been demonstrated and discussed by 1,71·() consultants Both in Hember Countries and in meetings such as the Inter- regional Water Standards Stuqy Group which was held in Manila in April 1956. This meeting had as its purpose the study of problems of water quality and examination of water on an inter-regional basis, the exchange of information from the various countries participating and the preparation of a report with recommendations for the consideration of an international WHO water quality study group to be held in Geneva in June 1956. With the increasing realization that the foundation for sound enviromnental sanitation programmes is the provision of a sufficient number of well-trained professional and sub-professional workers in this field, has come a notable acceleration of training programmes. Graduate training in the field of public-health engineering has been approved and will be initiated in one of the Member States during the next year. New programmes and revisions of existing programmes for training of sub-professional personnel have been put into effect in a number of the Western Pacific countries. Long-range national programmes for environmental sanitation have been a basic need of some countries of the Region for a number of years. In China and the Philippines, production of such plans is in progress and will be taken into consideration by the governments concerned. It is expected that in future years, WHO will place continued emphasis on stimulating countries to develop national long-range environmental sanitation plans, as well as to strengthen training activities in the field of environmental sanitation. These efforts, together with the assistance which may be offered in solving specific and immediate problems by the use of projects or consultants in individual countries, and by awarding of fellowships, should serve to accelerate the tempo of improvement of the environment in countries of the T,v0stern Pacific. 1.5 Health Education Contrary to popular belief among health workers the people do not place the same importance on health as trey do. It can 00 said in fact that health as such is not a basic need of the majority of the people. Experieme has shown that the average person does not separate health from his total living pattern and although ha may desire happiness am a feeling of well-being, he does relatively little thinking about health as such. In many instances people's motivations regarding certain health habits and behaviour are quite apart from health at all. As an example, tre adolescent who formerly took little interest in his personal hygiene Slddenly becomes WP/RC7/3 Page 23 extremely fastidious when he wants to become attractive to the opposite sex. Again mothers may take their children to the clinic s and follow the instruc- tions given merely because they feel their children are not progressing as well as the neighbours' children. It is becoming increasingly apparent that health habits and attitudes cannot be changed simply by giving proper informa- tion and telling people the right things to do. It has been found that an approach must be made to the people in terms of their current beliefs, interests, and motivations, and through the channels of their own social organizations. One of the most important tasks in the improvement of the level of health in a particular country is for the people themselves to understand and accept responsibility far their personal and community health problems. Health workers themselves must therefore, in addition to their technical skills and competencies, have the insights and the ability to use this educational approach in the pursuit of their work if the people are to make the' necessary cha nges and utilize to the maximum available health services. It thus becomes the purpose of health education to develop des:irable health attitudes and practices among the people based on their own customs and pattersn of life and to encourage them to work together respon- sibly for the improvement of health conditions in their neighbourhoods and communities. The health-education activities of the Regional Office have been directed to assisting governments implement this objective. The highlight of the year was the Inter-regional Nutrition Education and Health Education Seminar held at Baguio, Philippines, in October. This seminar was sponscred jointly by the Western Pacific ani the South-East Asia Regional Offices, together with the Food and Agriculture Organization of tl:e United Nations. As a d:irect result of the seminar, three countries are planning similar meetings on a national scale and it is anticipated that others will follow. In Australia as an outcome of the National Health Education Seminar held in Januar,y 1955 (at which the Chief of the Health EdUcation of the Public Section in Headquarters and the Regional Health Education Adviser served as consultants), and this country's participation in the FAO/WHO Seminar, a health education sub-committee of the National Health ani Medical Research Council was established in March. This committee was organized to study the health-education problems and tha needs for health-education personnel ani training in the country. Such national meetings and committees for health education are encouraged as they are means of further higtllighting the importance of the modern health-education approach to all types of health work. In the interest of continuity for furthar assistance to countries and territories in the development of health education, it is felt that a regional seminar in 1959 devoted to a consideration of health-education training for health workers, including health educators, would be des:irable. Another indication of the growing interest in health education throughout the Region is borne out by the fact that WHO fellows from five WP/RC?/3 Page 24 countries and territories are completing overseas training in malth education this year and six reque sts for similar training during the next two-year period have been received. Tmse fellowships are awarded to senior goverIll1l3nt officers who will return to key health education positions in departments of health as well as in departments of edooation. Health-education training in the Region was furthar advanced this year by the establishment at the Insti tute of Hygiene, University of the Philippines, of a major course in public-health education. This is a graduate-level course and is of a standard comparable to training provided in schools of public health in the United States. This is the first time such a course has been offered in the Region and it is envisioned that it will be used as a regional centre for advanced health-education training. The Regional Health Education Adviser was invited to assist in the development of this course and during the year he also taught a course in health edooation to a group of physicians at the Institute of Hygiene. Consultant services have also been given to the Department of Health in the development of a health-education programme. Negotiations have been completed between the Health Education Section of the Japanese Public Health Association and the Organization, whereby tm report on the first session of the WHO Expert Committee on Health Education of the Public will be translated into Japanese. The Japanese Public Health Association plans a wide distribution of the report to health agencies throughout the country. Following a request from the South Pacific Commission the Adviser spent two months visiting selected territories in the South Pacific. The purpose of this visit was to stuctv the health-education needs and problems in the area and to make recommendation for technical assistance. The Adviser travelled with the Research Officer for Health of the Commission and the joint report of these two officers has been made one of the Technical Papers of the Commission. Plans were made for a joint SPC/WHO sponsored eight-week health-education training course for island workers to be held in Noumea in 1957. The Commission is submitting the request for this course to the Technical Assistance Board. As a part of this project, an international health-education specialist will be assigned by WHO to the Commission for a two-year period'to g1 ve guidance to tha course trainees when they return to their own posts. In conclusion, it can be said that significant progress is being made throughout the Region in health education but stress reeds to be placed on the improvement of the training of all categories of health workers in the concepts of methodology of health education. 1.6 Miotal Health The same difficulties which were outlired in last year's report continue to delay rapid progress in this field, in spite of growing interest in the majority of the countries of the Region. Indeed, it is becoming very clear that long-term experts in mental malth are not available, and that WP/RC?/3 Page 25 unless the same short-term consultant visits a country at frequent intervals, the value of one visit is limited. Further, it is clear that progress can only be achieved by sending overseas carefully selected fellows who have the calibre to become community leaders in preventive mental health. Such fellow- ships usually need to be of two-three years duration to be effective. Still more difficult is the finding of the right type of fellow, and in spite of the most careful search, on several occasions it has proved impossible to find a candidate whom the training institution will accept because of the lack of proper background and experience. It is not a field to which governments find it easy to attract the personnel of the quality needed. , A major factor in this dearth of candidates is undoubtedly the poor quality of the teaching given in many medical schools of the Region in psychological medicine, and the failure to give this discipline the place in the curriculum it deserves. This is indeed a field which governments might consider in asking for assistance to strengthen medical faculties. It is a curious paradox, that while public interest in several countries is great, there is a failure of universities to provide the training of the personnel who are needed to satisfy the public demand. In Taiwan, China, the three fellows who attended the Mental Health Seminar in Sydney sponsored by WHO and Australia in 1953 are actively stimulating interest in men tal health. A short-term mental-health consultant who visited Taiwn during the period under review, recommended that the Department of Neurology and Psychiatry of the National Taiwan University Medical School should establish and operate a children I s psychiatric centre. This matter is now being considered by the Government and WHO fellowships have been awarded to the Associate Professor of Psychiatry and his assistant for overseas stUdies. The Government of the Federation of Malaya, in pursuance of the MacKeith Report, has made plans to train assistant mental nurses, a WHO mental nursing tutor is under recruitment, and a fellowship is being awarded this year in me..'1tal ... heal th nu:' sir.g. In continua +.ion of WHO assistance to the ['::eternal and child health project, a mental-health consultant visi ted Hong Kong, A considerable amount of interest in mental health was aroused among government, up~versity, professional, church and civic groups [.8 a rec:;ult of this visit. Assistance has been given in the planning of two child guidance centres an:J. recommendations made v>ith regard to the fr.llowship required to support the programme. Several fellowships have been awarded by WHO to train personnel to help Hong Kong prepare for the opening of a new mental hospital. In Japan during recent years, the care and management of orphans and homeless children, adoption, and juvenile offenders have been problems of great magnitude. For several years, WHO has been giving assistance in the form of consultant services, fellowships, equipment and supplies, and medical literature to the National. Insti. tute of Mental Health, which WP/RC7/3 Page 26 undertakes research and training in addition to serving as a service unit. The Government now plans to establish mental-nygiene clinics at strategic places throughout the country am further assistance in 1958 has been requested. The Government of the Philippines maintains great interest in this field as recorded last year. It has made financial provision for a section of mental health, but so far it has failed to find a suitable candidate to make use of a WHO fellowship in the public-health aspects of mental health. During the year under review, four fellowships were awarded to the Government of Singapore in the fields of preventive psychiatry, child psychiatry, child psychology and psychiatric social work in furtherance of assistance to the progressive programme which the Government is developing. A sign of this growth is the offer of the Government of Singapore to request the Organization to hold a regionaJ. conference in mental health in Singapore in 1958. Provision for this conference has been made and the exact eubject matter of the conference is under consideration. Recruitment of a WHO mental nursing tutor for Singapore is in progress to assist in developing a training course for mental nurses. 2 EDUCATION AND TRAINING 2.1 Assistance to Educational Institutions During the year, the Adviser on Education and Training or the Public-Health Administrator visited all educational institutions where assistance is being given. Details of these projects can be found in the relevant project summaries. It is gratifying to note that agreement, at least on a short-term basis, has been reached with the University of Malaya am the London School of Hygiene and Tropical Medicine on the exchange programme. During the fir st two years of the course for the Diploma in Public Health, special provision was made to offer a limited number of fellowships to countries of the Region, and fellows have attended from the Federation of Malaya, Netherlan::is New Guinea, Hong Kong and the Philippines to support the new course. It is hoped that now that the course is esta- blished, continued support will be given by those countries of the Region without national training facilities. In Cambodia, WHO has joined AIoorican and French Economic Aid in giving assistance to the Royal School of Medicine. The Director of the School and his counterpart, who was assigned by the University of Paris, were awarded WHO fellowships which permitted them to visit medical schools in India, Burma, Thailand, Hong Kong, the Philippines and Taiwan, China. WHO is financially supporting four lecturers and a proportion of the annual WP/RC7/3 Page '27 enrolment of Cambodian students. The School is also training Laotian medical officers, of whom eight are there on WHO fellowships. In Taiwan, China, assistance to the National Taiwan University School of Nursing has been given during the past several years. I am glad to be able to report to you that the Governmant is planning to strengthen further the Medical School and the Institute of Public Health and, in this connection, has aS,ked WHO for a small amount of assistance. Assistance to the Central Medical School, Suva, has been most successful. Unfortunately, for private reasons, the WHO lecturer in physiology resigned before the end of his contract, and a successor is anxiously awaited both by the Government and the Medical School. So far, it has not been possible to negotiate an exchange programme with a university medical school. Apart from the assistance that is being given in Japan to institutions such as those for prerna tm'e infants, crippled children arrl mental health which are service as well as danonstration and training centres, WHO has helped the Insti tute of Public Health and the Institute of Hospital Administration during past years by awarding fellowships, providing equipment, supplies ani medical literature am by furnishing consultants. The units in the Institute of Public Health which received WHO assistance were the Departmmts of Nursing, Medical Social Service arrl Epidemiology. The Institute has offered its services as a training centre and a number of Japanese-speaking fellars from Taiwan, China, have alreadY benefitted from this service. The exchange programme between the Ins titute of Itrgiene of the Uni varsity of the Philippines and the Johns Hopkins School of Itrgiene and Public Health continues to function, but it is evident that the Johns Hopkins School is having increasing difficulty in finding associate professors to complete an academic year. In view of the considerable assi stance to the Institute of Hygiene now beginning from ICA, it is highly probable that there will be no further eoctension of the pro ject beyond the' end. of the 1958-1959 academic year, when ICA aid will be at its naxi.mum. Assistance has been reduced to half the original amount for the academic years 1957- 1958, 1958-1959. During the year, a survey of the reeds of three private medical schools in the Philippines was made by a WHO expert on medical education. His report is under consideration by the rredical schools and by the Govern- ment. An interesting development towards the end of the year was a request from the Territar,y of Papua and New Guinea for a fellowship for the Director of the Division of Medical Education to visit substandard medical schools with reference to the foundation of such a school in the Territory. WP/RC?/3 Page 28 i I j f \ ,..--in Viet Nam, WHO joined with ICA in assisting the School for Health Technicians, which was recently started to train a sub-professional grade of health workers for the rural areas, A WHO fellowship made it possible for the Director of the School to visit several countries in this and the adjacent South-East Asia Region where such level of training is undertaken. The. Government has requested the continuation of WHO assistance for this project. 2.2 Fellowships Excluding participation in seminars and expert meetings held within and outside the Western Pacific Region which are mentioned elsewhere, 126 fellowships (this includes awards issued in application of the principles embodied in Resolution WHA6.35 to ten national candidates to maintain them in attending a national training course organized with the help of WHO) were awarded during the period under review. Seven of these were for attendance at the short group training course in Vital and Health Statistics held in Saigon, Viet Nam in April 1956 and twenty are for attendance of the Refresher Course for Assistant Medical Practitioners in Preventive Medicine and Village Hygiene being held in Apia, Western Samoa (first group: 1 June to 15 July 1956; second group, 16 July to 31 August 1956). The fellowship months for the 126 fellowships total 954.5. Their distribution according to fields of study and countries of origin is shown in Annex VII. Of the 126 fellows, 56 (regular fellowships: 19, the rest are for attendance at group training courses) or 44% observed or studied wholly within the Western Pacific Region. Twelve studied partly in the Region with visits to other countries outside the Region forming the remainder of their fellow- ships.. This is a gratifying fulfilment of the policy adopted by the Regional Cormnittee to use regional facilities as far as possible with efficiency. Last year, placement for study within the Region was arranged for a number of candidates from outside the Region. The distribution of fellows from other regions who arrived in the Region for study during the period under review was as follows: AFRO, one; AMRO, one; EMRO, five; and SEARO, eight. More fellows, including one from the European Region, are expected to arrive within the next few months. Of the 126 fellowships awarded, 28 were for less than three months in duration, 10 were from three to six months, 23 were from six to nine months and 65 were from nine to twelve months, some of these, parti- cularly in mental health, will be extended to cover a two-year period. As in previous years, a small percentage of students suffered from language difficulty, particularly in English comprehension, in spite of screening before departure by the ir governments. Apart from these exceptions, the majority of the fellows did ver.y well and groatly benefitted from their fellowships. ~ . . . 1 t WPIP!.C7/3 t. Pag~ 29 .\ I i The setting up of special screening committees to te'~riot only ability to speak, but to comprehend, is strongly urged. It was als 0 nec8ssary to r.;mind governm~nts of the need to observe the planning procedures for fellowsh~ps, in particular early sub- mission of applications and to submit with applications, particularly if placement in a United States school of public health is planned, complete documentation including a photostat copy of aiploma with a certified tran- ecript Qf the academic record and an English proficiency certificate. A diagram representing planning procedures in fellowships is shown in Annex VIII. I wish to take this opportunity to thank the host governments and their education and training institutions for their assistance am co-operation in making the fellowship programme a continued success. 2.3 Educational Meetings The year under review was a busy one in this field of activity. There were held: 1. Too Nursing Education Seminar in Suva, Fiji. 2. The TElcfmical Discus sions at the Sixth Regional Conrnittee Meeting, Singapore. 3. The Nutrition and H(;alth Education Seminar in Baguio, Philippines, jointly wi th FAO. 4. The ·wat6r Starrlards study Group, Manila, Philippines. 5. The Rsfre::sher Course in Preventive ¥Jedicine for Assistant Medical Practitioners, Apia, Western Samoa. 6. The Health Statistics Training Course, Saigon, Viet Nam. Details of these meetings may be found in other sactions of this report. In addition to the above, members of the Secretariat attended various educational meetings organized by Headquarters or other regions such as: 1. The Study Group in Filariasis, Institute for Medical Research, Kuala Lumpur, Malaya. 2. The Intra-Regional Conference on Malaria and the Ex.pert Committee on Malaria, Athens, Greece. WPjRC7/3. Page 30 : • . 3. The Environmental Sanitation Conference on Rural 1\Ygiene, Colombo, Ceylon. 4. Tb:; Second International Symposium on Yaws Control, Enugu, Nigeria. and by countries such as: 1. The First hsio.n Pacific Ttberculosis Conforence, Sydney, Australia, assisted by the Colombo Flan. Further, in the course of tmir visits to countries, advisers and public-health administrator s were often asked to attend educational meetings. There are too many to list in detail, blt examples are: 1. The Annual. Conf~rence of Provincial an:i Municipal Health Officers, Baguio, Philippines. 2. The Sister Tutors' Contereme, P~nang, Federation of M:llaya. The attention of governments is dr~wn to the att,endance of Secretariat members at important national conferences with educational purpose. While it 'Would not be possible for special visits for such a purpose to be made often, it would be appreciatdd if, when a visit coincidad wi th such a meting, an invitation could be issued. Attendances at such confer nces are of the greatest importanre to the Sacretariat in wilding up the intimate knowledge: of the problems confronting r-bmb.:::r St,ates which is essential to the giving of -3rfici rot service. 3 CmMUNI CABlE DISEASES 3.1 Malaria Control Technical assistance has been provided to malaria programes in the Region, and governments have been (:ncouraged to transform tho objootive of thoir antimalaria activities from control to eradication. At the sam time, malaria fellCMships hav\:; be~n awardl.11 to str(:ngthen malaria services and to prepare local personnel to undertake ~~l~ria surveillance activities follOWing th4:l interruption of malaria tra'rlslI'Iission. :\nsic:t.g.nce from UNICEF and from IC~ has been of considerablo hal p in .. h:vE:loping and expanding t~ malaria-control activitivs in a number of coulltric·r:; in thu Re~i.on. The need for inter-country co-ordination ani co-operation, particularly in respect of malaria control in count.r1es with common borders, has been felt, am. steps have been takon by tho Regional Office to meet this through t!w organization of int ..... country conf'e:renc..:.ls of malaria workers and public-health administrators. A malaria conference was held in Phnom- Penh in J~ 1956 which W3.S attended by repr";.sentatives of tho GovomlOOnts of Cambodia, Laos, Thailand. and. Viet Nam, as well ~s representativos of ICi\ , WP!BiJ7/3 • t:ase 31 , in the same countries. This was tollow~·.:i in February 1956 by the First Borneo Malaria Conterenco in Kuching attamed by representatives of Brunei, North Borneo and Sarawak, and a rtl'rasentative of UNICEF. These conferences stressed tm importance ot inter-co\Ultry co-ordination of antimalaria pro- graJlll'leS and passed appropriate racomm.endations to promott:: this obj active. The meetings so tar held haVf-' shown that the countries co~erned earnestly wish to work towards the aim of eradic ation. WHO malaria beams have b~~n assist il'.g the Govornmmt S of Cambodia, China (Taiwan), North Borneo and SRrawak. In addition, ~chnical advice has been given through the visits of tro RGgional Mcl.aria hdviser to a nUJli:)er of countries, including Netherlanis New Guinea, Hong Kong, Macau, Laos, Viet Nam and the Philippin~s. The malaria programme in Taiwan, China, is on the way to complete eradication and the progranme in the Ph11ippims has bo~n modified to attain the sarrs objecti va. Certain technical problell'5 have bedll encountered in the expansion of the project in Cambodia but rGYledial ~asureS have beon instituted. The rasults of tho programme in Sarawak have been satisfactory and the axpansion of the llre4 of operatiOns has been undertaken. In North Born(:j(), the preliminary observations in:licate satisfRctory rosults with residual insecticides and spraying operations havo been started. There has not yet boen any report ot the development of resistance of malaria vaotor sp€cies to insecticid(:ls in the Western Pacific Region, ani tmre is I'il;~SOn to b(:;li~ve that malaria cre.dico.tion may be achieved in most ar&as ot the Region by mc.ano of rE;sidual insocticides alone" in some cases, however, it appears that suppl~lllentary measur(:;s, such ·.as the administration ot antimalarial drugs, may be to\Uld necessary. 3.2 Tuberculosis ani BeG Tuberculosis campaigns carried out r:luring the ~ar by governments with the assistance of the Organization were largely concerned with BOG vaccination. The progt'aJ!llD3s in active operation wore those in Cambodia, China, the Philippines and Viet Nam. The objecti ws werl;) to rest and vaccinate the sections of the populations specified in thl3 plans of opera- tions am it is gratifying to report that the targ~t figures have beun achieved. The cwnulative tot",.ls tor all campaigns in tb3 Region up to 31 ;!..crc:. 1)56 "n~rc;: test~d vaccinated : 13 582 212 : 6 355 614 International assistance has ceased in respect of the BCG campaigns in Brunei, the F"dera. tieD of i\falaya" Hong Kon!:;, Sarawak anj Singapore and the work is being carried on by the respective governnmlts. WP/RC?/3 Page 32 A new campaign in Netherlands New Guinea, assisted by WHO and UNICEF, began in May. The consolidation of BCG .campaigns in order to ensure their continuation and integration into the permanent public ... health services of the countrie s has received much attention during the year both in tte Region and at Headquarters. The difficulties of consolidation are considerable and tte best approach is still uncertain. A pilot project was started in the Philippires in June to assess two possible methods. In tte Federation of Malaya, consolidation has taken place into the permanent public-malth service, but at the cost of a severe drop in the volume of work. In Hong long, consolidation has been effected more into the specialist tuber- culosis service and has given rather better results but at the cost of maintaining special BeG personnel. The difficulties of consolidation have led several governments to continue their' mass campaigns with international assistance until the situation is clearer. The BCG assessment team, which worked in the Region last year, has issued two reports which show the excellent work which has been done but also point to two disturbing findings: one is that in some countries in the Region, there is a large amount of non-specific tuberculin sensitivity, and the other is that the comrersion rates in our mass campaigns are lower than had been hoped. These are technical questions' to which answers appear necess~ to improve the efficiency of the work. TlEre MS been an increased emphasis on overall tuberculosis- control projects in which BeG will be an integral part. The advanced control programmes in Australia and New Zealand have not'sought any assistance from WHO, and' in Japan, Hong Kong and the Philippines, only fellowships have been provided. The expanding control programme in China, Taiwan, has received fellowships and a senior adviser from the Organization. In Brunei, Cambodia, the Federation of Malaya and Viet Nam, among other countries, discussions have taken place concerniqs the possible role of international personnel, but negotiations are still in the formative stage. Although these Member Countries vary greatly in the level Qf .tuber- culosis control, a common trend is found in all: there is less emphasis on beds and building of costly institutions and more emphasis on tte use of the new drugs to treat large numbers of infectious cases on a domiciliary or ambulatory basis. Considerable observation and research will be reeded to discover the best methods and a number of studies are being conducted for the purpose. The Regional. Office, with guidance from Headquarters, is still ,assisting governments to develop simple methods of di agnosis and treatment which will give the greatest possible results with the least expenditure of funds and personnel. The Asian Pacific Tuberculosis Conference, held in Australia in August 1955, was attended by delegates from many Member States and was regarded as a most successful meeting. 3.3 Venereal diseases ani Treponematoses 3.3.1 Yaws WP/RC7/3 Page 33 In the field of yaws control, the activities for the past year have been directed towards stimulating governmEnts to survey their yaws problem and, where indicated, to umertake appropriate control projects with the help of WHO. Assistance has also been given to countries with projeots already in operation to make these more effective. In Laos, WHO oontinued to as&ist the yaws contr.ol projeot, which is carried. out with bilateral assistance, through the assign- men t of a medioal offic er, who extended tre project to the two southerly provinces bordering on Thailand. Tre WHO medical officer also undertook a survey of tre venereal diseases in the country at tre request of the Govern- ment. In neighbouring Cambodia, the Government is planning to recommence the campaign against yaws with hllateral assis tance an.:l has reqU3sted the assistance of WHO in the form of the technical services of a medical officer. This has been planned fer 1957. When this project is in operation it will complete the establishment of yaws control activities in the three adjacent countries of the yaws endemic area composed of Camtodia, Laos and Thailand. In the Pacific Island Territori;~s .. much progress was made dur ing the ye ar towards planning and or gani zing, or strengthening, projects for all the territories in which yaws is endemic. The pilot project in the WHO/UNICEF-assisted programme, started in Fiji at the end of 1954, and that started in Western Samoa in the middle of 1955 .. have almost been completed, also tl'B initial treatment surveys plarmed, and the WHO team is at present in tre British Solomon Islands Protectorate assisting the Govern- ment in establishing a similar campaign. The Governments am also tre people have co-operated to the fullest extent in these projects and have freely expressed their full appreciation and satisfaction with tl~ successes so far achieved. In Netherlands New Guirea, the campaign planned with the assistance of WHO, was started in April 1955 and has been effectively executed by the na ti.onal. teams. It is anticipated that the initial treat- ment surveys of tre population unier the control of the Government will be completed by tre end of 1956. Plans have been made to establish projects in the Gilbert and Ellice ISlands, the Cook Islands, Niue, the Kingdom of Tonga and the Condominium of the lew Hebrides at too rsque st of the several GoveIrulJ3nts during 1957-1958. The campaign in the Australian territories, including Papua and New Guinea, is being carried out independently by the Goverl'lllEnt, and when these progra.Il1l1ES, planned for 1957-1958, are put into WP/RC7/3 Page 34 operation, there will be oontrol projects in practically all the yaws endanic areas of the South Pacific and the hope of realizing the goal of the elimination of yaws from this area will be that much nearer. The campaign in the States of Kelantan and Trengganu, Federation of Malaya, started in April 1954, was continued by the national teams with consistently good field work, but it was not possible to accele- rate tre prq?;ress of tre work for lack of necessary additional personnel. The project in the Philippines has been continued as part nass treatment campaign by the national yaws control teams and part "integrated" yaws work by'the national rural-health p3rsonnel with the help of the national yaws team. With the rapid development of the Philippine Rural Health Prq?;ramrne, which plans to establish 1300 rural-health units by 1958, the field work of the project suffered during the latter part of 1955. HGlever, official instructions have been issued by the Government integrating the ;yaws control activities into the routine of the rural-health units and during the first half of 1956 there has been a spectacular rise in the reported activities of the project. It is anticipated that the Philippine Rural Health Project will develop effectively and will automatically secure too successful integration of too yaws control work wi thin the next few years. During December 1955 and the early part of 1956, an outbreak of poliomyelitis in Western Samoa occurred and several cases of paralysis appeared in cases who had received injections of penicillin. This coincidence caused great consternation among the population and the health authorities, and adversely affected the operation of the yaws control project. The resistance of the population to receiving injections of penicillin for fear of paralysis has, however, been to a large extent overcome, and the project continues. The projects in Laos, the Federation of Malaya and the Philippines, which were started before 1954, employ the selective treat- ment of the population, but sime 1955 the treatment of the total population has been the policy recommended for areas of high prevalence of yaws. This has been adopted ~ all the Pacific Islands Territories including Netherlands New Gyinea, and was recommended' for the Federation of Malaya but has not been implemented far various reasons. 3.3.2 Venereal Diseases In the field of venereal-disease control, activiti es during the year have been directed towards encouraging countries to study the problem of the venereal diseases and; where appropriate, to undertake the necessary measures far their control. In Laos, the WHO medical officer attached to the yaws control project carried out a preliminary survey of the venereal disE;:ases at the reque st of the Government, and presented his findings for consideration wPjRC7/3 Page 35 in the development of a venereal-disease control project, planned for implementation in 1957. As the Government is also interested in establishing a general laboratory service, the serologic laboratories planned for the venereal-disease control project are to be set up as general laboratories. Japan and Korea received fellowships for medical officers to study public realth, with special anphasis on venereal-disease control, to assist·them to strengthen the venereal-disease control projects in these countries. In Taiwan, China, assistance was continued for the venereal-disease control pro ject which has been expanded to provide facilities for exaIllina tion and treatment through 425 medical and health units of the country. Intensive training of personnel, including fellowship for study abroad, was continued am two field health units have been organized to strengthen the supervision of the work and to un:iertake a mare aggressive approach to the control of the diseases. The Government is interested in broadening the scope of the work of the teams to include, for example, lepros,y control am in effecting the integration of the work into the routine activities .of the rural-heaith organization. . 4 ENDEMO-EPIDEMIC DISEASES 4.1 Filariasis and other insect-borne diseases 4.1.1 Filariasis The important event of the year in filariasis was the holding of the Study Group in Filariasis in the Institute for Medical Research, Kuala Lumpur, Federation of Malaya, during the period 6-15 December 1955. The Public-Health Administrator" Dr •. J • .H. Strahan, and the Regional Adviser on Malaria, Dr. F.J. Dy, attended from the regional office Secretariat. Members of the Study Group active in filariasis research in this region were: 1. Dr. J.F. Kessel, University of California of the Filariasis Research Unit from the Institut de Recherches Medicales de l'Oceanie Fran~aise. 2. Dr. E. Massal, rept"esenting the South Pacific Commission. 3. Mr. T.A. Reid, Institute for Medical Researeh, Kuala Lumpur. 4. Mt-. C.B. Symes" Colonial Medical Filariasis Research Unit, Suva, Fiji 5. Dr. T. Wilson, Institute for Medical Research, Kuala Lumpur. wP/RC7/3 Page 36 Observers also interested in the problem attended from the University of Malaya, the Institute for Medical Research, the Armed Forces and estate medical practice. The report of this study group is awaited with great interest as a guiding document to the policy to be adopted by the Regional Office in giving assistance to countries in filariasis control. 4.1.2 ~'Gwopod-borne Virus Diseases Interest in the arthropod-borne virus disease~ and virus disease~ in general, in the Region continues to grow. Active research work on the arthropod-barne virUseeis known to be in progress in Australia, the Federation of Malaya, Japan, North Borneo and Singapore. The papers submitted by experts in the Region in the previous year have been prepared as resource material for a future study group. Provision was made in the 1956 budget for such a study group, but action has been withheld pending a decision from Headquarters on the appro- priateness of combining it with an inter-regional conference and training course. 4.2 Leprosy Leprosy control has, of course, been practised for many years in the various countries in this region. Recently, however, there has been a major change in the outlook resulting from the successful use of sulphone drugs. Compulsory segregation an:i treatment are now being employed less and less, while campaigns based on the mobile public-health worker and the domiciliary patient are being developed to an increasing extent. In this new type of control programme, extensive case-finding by special teams reveals considerable numbers of leprosy pati ents who are treated by sulphone drugs at home. Segregation is restricted to certain groups and the abolition of compulsory segregation has caused large numbers of sufferers to come for- ward voluntarily for treatJnen t. A pilot project on these lines began in the Philippines in July 1955 with the assistance of WHO arrl UNICEF. A WHO consultant will proceed to the British Solomon Islands Protectorate very soon to advise on a similar campaign there. Preliminary discussions have taken place for work on a similar type in the Federation of Malaya arrl in China. There has been an increaSing demand for fellowships in leprosy control from various countries in the .Region. During the year, there has been a greatly increased exchange of technical information between the Regional Office ani Member Countr~es, more especially the Federation of Malaya, Fiji, Hong Kong, Japan arrl the WP/RC7/3 Page 37 Philippines. I am indebted to the countrie s concerned for placing their lmcwledge and experience at the disposal of all, and also to WHO Headquarters and. various territories in Africa. Although large-scale programmes of domiciliary treatment hold out much hope for the futllre, there are still technical questions which remain to be solved. These include the best measures to enSUl'e that the patients take their 'drugs and a1 so the best drug to give and the best method of giving it. It is expected that pilot projects now in operation will also help to clarifY such matters as case-finding, the accurate tollow- up of infectious cases, the role of segregation and what legislative changes may be needed in the new si tua tion. 4.3 Poliomyelitis 4.3.1 Regional Poliomrelitis Centres To further the purpose of the Organization to establish a network of poliomyelitis laboratories over the globe to consolidate epidemiological lmowledge of this important disease, it was decided to establish three WHO designated Regional Poliomyelitis Centres in,the Region with the following duties: 1. To identify, type and stu~ further poliomyelitis viruses and unident ified viruses isola ted from stools in all parts of the Region. 2. To make available the strains of virus isolated to other WHO Regional Poliomyelitis Centres and on req'lE st to' other research laboratorie s working in this field. 3. To undertake virus isolation from a limited number of specimens (stools, post-mortem material) 'from countries unable to carry it out themselves. The number of specimens will be strictJ.y limited to that necessary to recover atrains of virus for research purposes only, and not fer diagnosis. 4. To undertake co-ordinated research, in co-operation with oth3r WHO Regional Poliomyelitis Centres and other research laboratories working in this field, on such aspec~s of poliomyelitis as may from time to time be agreed between the directors of the laboratories coreerned in accordance with the general @lidance of WHO. WP/RC?/3 Page 38 5. To make available on a limited scale for reference purposes standard strains of virus and type-specific antisera to laboratories co-operating in the WHO research programme. 6. To report the occurrence of epidemics of polio~elitis in the area of influence of the centre am to evaluate as far as possible their extent and severity, and eventually to report on the types of virus responsible. This information should be sent in parallel to the appropriate Regional Offices of WHO and to the Epidemiological Information and MOrbidity Statistics Section of WHO in Geneva. The information 1. particularly required from areas in which national reporting systems are not well- developed. Where national reporting systems are satisfactory, information is needed on the virus typei, otherwise only incidents of particular importance need be reported. ? To receive fellows, sent by WHO for training purposes, in such numbers as the facilities available permit. 8. To report annually, or more often if indicated, on the work performed in the centre. To date, two laboratories have accepted these responsibilities: L The Department of Bacteriology, University of Malaya, under the direction of Professor J.H. Hale. 2. The DepartInent of Viral and Rickettsial Diseases, National Institute of Health, Tokyo, under the direction of Dr. M. Kitaoka. Negotiations with regard to a third in the South Pacific are in progress. All countries have been advised of the services available. Two thousand dollars has been made available to this region to finance visits of the directors of the laboratories to the countries designated as their responsibility. For special equipment, $2500 was given to the Singapore Centre and $500 to the Japan Centre. WP/RC7!3 Page 39 The Designated Poliomyelitis Centre, Singapore This laboratory is scheduled to serve the following countries: Brunei Camoodia Federation of Mal~ Hong Kong Indonesia Laos North Borneo Sarawak .Singapore Thailand During tre year, one fellow from Thailand proceeded on fellowship to the designated laboratory to learn sampling techniques. Survey wor k commmced in Hong Kong, which the Director is scheduled to visit shortly. OU~r visits are being arranged. The Designated Poliomyelitis Centre, Japan This la1:x>ratory is scheduled to serve the following countries: C~r.a, Taiwan ':apan Korea It is hoped that the designation of these Centres will stimulate and facilitate research which will help to make it possible to use the new control rooasure of vaccination intelligentJ..y as it becoroos available. For this purpose, amongst other things, information is needed on the antigenic and other characteristics of poliomyelitis from paralytic, abortive, and inapparent infections and on other stool viruses; ani on the age incidence of clinical disease and infection from all countries. Viruses isolated need to be exchanged and made available to otrer research laboratories. It is hoped that all countrie s will use the' facilities offered, both in the interest of each, and of the world at large. Other During the period under review, assistance has also been given to Taiwan, China, whe re the WHO maternal and child health adviser assisted the government in the planning of a trained emergency team of doctors, nurses and technicians in anticipation of poliom,yelitis outbreaks. In Japan, the National Crippled Children Hospital has a team of workers who received advanced training overseas under WHO auspices. This hospital serves as a demonstration and training centre in the care of post-polio and other orthopedic ally handicapped children. UNICEF is considering a request to equip twenty-two Crippled children centres to be established throughout the CoUll try. WP/RC7/3 Page 40 5 OUIER ACTIVITIES 5.1 The Role of Health Physics Education and Training in the Use of Atomic Energy During the year interest in this field appeared, and a request was received for a regional training course for health physicists. There is undoubtedly evidence that the use of atomic energy in industry ani medicine will grOW' rapidly in the countries of this region. Development in Australia is rapid. A reactor will begin to function in the University of Technology, Sydney, in 1957 and it is anticipated that courses for health physicists in radio-isotope utilization, and in environmental control of atomic wastes and other radiation hazards will roon be available for health physicists, engineers, doctors of medicine and public-health officers. During a recent visit to Australia by a member of the Secretariat, preliminary discussions were held with various authorities on prerequisites for training. It has also been announced that an Asian research centre for the peaceful usage of atomic energy may soon be in action in the Philippines unier the auspices of the International Co-operation Administration of the United Statee; and the Colombo Plan. Already Philippine fellows have been ani are being sent overseas for training in connection with this proposal. The suggestion to hold a training course has been held in abeyance pending the development of the above training centres, but here is a new field of regional activity which will develop. PART III - PROJECTS IN OPERATION 1 JULy 1955 ~ 30 JUNE 1956 WP/RC?/3 Page 41 This part of the Report contains a list of projects which were in oper~tion during too whole or part of the p3riod under review. In country projects1 the aim given in the list is that of the government in establishing the project, irrespective of the form or extent of WHOts assistance. In the first column "R" means the regular budget; "TAli means Tec hnical Ass:i.s tance funds; and "UNICEF" the United Nations Children's Funds. Names of other co-operating agencies are" given in parenthesis. Only projects in which actual field assistance has been provided by WHO are included in the following pages. W P/RC 7/'3 Page 42 Project No. Source of Funds Co-operating Agencies .Daecription British Solomon Yaws/Leprosy Control, Honiara (May 1956 - ) Islands Protectorate I R Aim of the project. (UNICEF) To reduce the prevalence of yaws by mass examination and treatment with penicillin; ultimately to eliminate the disease as a public-health problem; to train local personnel in the diagnosis, therapy and epidemiology of yaws. To carry out a leprosy survey, to register all cases of leprosy found and to start their treat- ment. Assistance provided by WHO in period under review. The international yaws team consisting of a medical offi~er, a serologist and a male nurse/administrator (since May 1956). Probable duration of assistance. From '3 to 5 years. Work accomplished. The WHO team, since. its arrival in the territory, has engaged in preparatory activities for the start of the project iml uding the making of radio broad- casts, the attendance of meetings at different levels and the training of the national field personnel. The Government has co-operated fully in these preparations, and special mention may be made of the arrangements made for travel between the islands ani the undertaking to provide efficient secretarial help from abroad. The pilot project was started in June on the island of little Malaita. Cambodia 1 TA (ICA) Cambodia 2 R Malaria Control, Cambodia (Oct. 1950 - Aim of the project. WP/RC?/3 Page 43 ) To organize antima1aria services; to demonstrate methods of ma1~ria control, by establishing demon- stration and comparison areas and training national personnel. Assistance provided by WHO in period under review. A malariologist and a public-health sanitarian (from August 1953); a six-month fellowship tc permit the national team leader to stuqy in Europe. Probable duration of assistance. Until 1960. Work accomplished. In 1955, the residual spraying operations were expanded to ClOver a population of about 180 000. Malaria trans- mission was not completely interrupted in some areas by this spraying progra.IlU'OO because of the usual prac- tice of the people to spend as much as six months a year in farm'huts'located in isolated and inacces- sible places. Efforts have therefore been made to find and spray all the farm huts (in addition to the houses in the villages) and antimalarial drugs have been used as a supplerentary measure to tre spraying operation. Training of local staff and spraying squads has been undertaken. The present spraying programme is well under 'Hay to cover a population of about 400 000. Public-Health Administration O~ov. 1953 - Sept. 1955) Aim of the project. To improve public-health administration by (1) surveying health conditions, (2) making long-term plans and (3) co-ordinating health programmes. WP/RC7/3 Page 44 Cambodia 3 R Assistance provided by WHO in period under review. A specialist in public-health administration (November 1953 until September 1955) to help with the above work and co-ordinate the health work of international agencies. Work accompli~. The WHO public-health administration specialist co-ordinated the work of the WHO and/or UNICEF-assisted projects with that of bilateral agencies. Through agreement between the Government, WHO and US-ICA, he and the other WHO field staff in Cambodia acted for a time as advisers to the US-ICA Mission in Cambodia and as US-ICA advisers to the Government. This project was discontinued with the appointment of an area representative for Cambodia, Laos and Viet Nam, who is now stationed in Saigon. Nursing Education, Phnom-Penh (Dec. 1951 - Aim of the pro ject. To set up a school of nursing in Phnom-Penh; to develop nursing and midwifery training. ) Assistance provided by WHO in period un:l.er revie"!. A senior nurse educator as team leader (since Dec. 1951) and three nurse educators (one since Nov. 1952 and two - in general nursing and midwifery - since August 1954). Probable duration of assistance. Unti 1 end of 1961. Work accomplisred. A new basic nursing-education programme was esta- blished in October 1954 with thirteen specially selected students. The WHO nursing-education team was g~ven responsibility for planning and super- vising practical experience as well as providing theoretical instruction for this group. In October 1955 the WHO team took over classes in Cambodia 4 TA (UNICEF) WP/RC7/3 Page 45 nursing arts for all students in the government school of nursing but has not yet been assigned responsibility for supervision of their practical work. Plans are being made for re-integration of UE special group into the larger class. Assistance in midwifery education was first given in trn training of rural midwives (six-month course) am in 1955 was extended to the three-year midwifery training programme of the government school of mid- wifery. Experience in prenatal clinics is now being provided for both groups. Further assistance in the improvement of clinical experience in hospitals and development of a domiciliary practice field are planned for tl'E future. Counterpart personnel selected from nurses who attended the early supplementary courses are gradually assuming greater responsibility for teaching. It is still diffi- cult to find nurses and midwives whose professional background and the facility in a foreign'language are adequate for fellowship study abroad. The main difficulties encountered relate to the inadequate level of basic education and the tradition- ally limited concepts of the functions and responsibi- lities of nurses and midwives. A new school and dormitory building provided by ICA for nursing and midwifery students is nearing completion. WHO will assist in training nurses and midwives at a professional level when it is agreed that the time is appropriate for this step to be taken. Maternal and Child Health, Phnom-Penh (Jan. 1952 - Aim of the project. To teach modern methods of maternal and child care suitable to the cultural background and financial resources of the country i to improve teaching of obstetrics and child care in the Phnom-Penh SChools of nursing and midwifery; to improve the teaching of paediatrics, obstetrics and gynaecology at the Royal School of Medicine i to demonstrate methods of combining the curative, preventive and educational ) WP/RC7/3 Page 46 aspects of health services; to extend maternal and child health (including school health) services and make them part of the countryrs health services. Assistance provided by WHO in period under review. Two medical officers (one from January 1952 - January 1956, the other, January to July 1955); the replace- ment far the second medical officer arrived September 1955; and a public-health nurse educator (since October 1954). Probable duration of assistance. Six years. Work accomplished. Paediatric services and training Two 25-bed wards are in full operation at the Preah- Ket-Mea1ea Hospital. Government staff have now taken over responsibility for the medical and nursing ser- vices and the clinical training programmes. 'During the year assistance has been given to teaching paediatrics and school health to students at the Royal School of Medicine. Maternal and child health services and training in Phnom-Penh Prenatal consultation clinics have been started at the Preah Sihanouk MUnicipal Dispensary and at the Preah-Ket-Mea1ea Hospital Centre. Pre and post-natal and infant consultation clinics have continued as part of the general activities at the Satheavong Health Centre where home visiting is also carried out within a limited area. Assistance has been given to the in-service staff training programme and to teaching students attending this centre. School Health A demonstration school-health service has been established at the Preah Che.y Chesdha School in Phnom-Pemh and is being used for in-service staff training, prior to expansion of the programme. Considerable attention has been given to hea1th- education activities and to preparing teachers Cambodia 5 TA (ICA) (French Economic Mission) WP/RC7/3 Page 47 and students at the Ecole Normale for this work. Plans for developing school-health programmes in the provinces and in rural areas have been discussed with health and education authorities, and with other international agencies. Royal School of Medicine, Phnom-Penh (July 1953 - ) Aim of the project To improve tIE standard of teaching at the Royal School of Medicine with a view to its upgrading to professional level; to expand the present facilities for the training of hospital assistants. Assistance provided by WHO in period under review. A lecturer in clinical medicine (including phthisiology) and a lecturer in ophthalmology (since January 1956); and $5000 worth of supplies and equipment; in addition, WHO has maintained half of each baccalaureate class of a maximum of twenty students since October 1955. Probable duration of assistance. Until end of 1958. ,\-lork accomplished. The awarding of WHO fellowships to a portion of each baccalaureate class released government scholarship funds for the financing of a smaller number of medical students at a higher stipend rate. This enabled the school to attract students with higher educational background. The WHO equipment, supplies and medical literature strengthened laboratory facilities and the reference library, thus facilitating teaching and research. The WHO personnel, in addition to raising the standard of lectures at the school, established clinics at the Phnom-Penh hospital, thus providing patients with services in special fields and clinical demonstrations and practical experience for the medical students. WP/RC7/3 Page 48 Cambodia 6 (UNICEF) BCG Vaccination (January 1955 ) Aim of the project To organize and carry out a mass BCG vaccination prograrmne as a means of affording irmnediate protection to an important section of the community; to lay the foundations for th~ establishment and expansion of a national BCG vaccination service as part of the tuberculosis-control service. As~istance provided by WHO in period under re"view. A medical officer (from January to December 1955 jointly with Viet Nam 4) and a BeG nurse (from January to September 1955, and from July 1956). Probable duration of assistance. WHO UNICEF: until 31 December 1956. through 1957. Work accomplished. The work continued steadily through the year with four trained teams, under the capable direction of tre Cambodian prograrmne manager and, during part of the year, of the international doctor and nur se • At 26 May 1956 the cumula ti ve totals were: tested 438 977 vaccinated: 225 147 which were approximately equal to the target figures. The new criterion for vaccination was introduced in February, resulting in an increased percentage of vaccina tions without any increase in complications. Re-testing of one group showed a conversion rate of over 9~ which was very satisfactory. In May, the Government introduced a new administrative system, clivi ding the country into four zones each with one team, and it is hoped that this will lead to a larger volume of work. WP/RC?/3 Page 49 China 1 Venereal-Disease Control, Taiwan (Aug. 1953 - ) R (fellowships TA) (UNICEF) Aim of the project. To control venereal diseases by training local person- nel in case-finding, contact investigation, health education and modern I1Ethexis of diagnosis ani treat- ment; to improve laboratory services and standardize laboratory methods; to establish an island-wide venereal-disease control programme. A ssi stance provided by WHO in period under review. A venereologist team leader (since July 1955); two twel ve-months fellowships to permit medical officers to take their MPH degree in the United States, majoring in venereal-disease control, am a six-month fellowship in health education have been awarded • . Probable duration of assistance. Until 1958. Work accomplished. The past year has been a period. of strell8thening of the venereal-disease control project which, during the previous two years, had been organized arrl expanded to provide facili tie s for examination and. treatment for the whole of Taiwan through the 22 health centres, 365 health stations, several hospitals and 22 serologic laboratories, and of planning a broader and more aggres- sive approach to the control of the diseases. A rapid 'survey of the activities of the project during the latter half of 1955 revealed the need for continued training and supervision of the personnel of the 453 health units participating in the project, even though the national project personnel of the demonstration clinic and centre and tbe reference serologic labora- tory had attained a high standard of proficiency in their work. Continued training ani re-training of the numerous doctors, nurses, midwives, sanitary inspectors and laboratory technicians, both in the service of the provincial health administration and in private practice was therefore carried .out. The national venereal-disease control officer, who had a WHO fellQiship to enable him to study public health, majoring in venereal-disease control, at WP/RC7/3 Page 50 China 3 TA (UNICEF) the Johns Hopkins University, returned to join the project after successfully completing his studies. With the award of fellowships to two other medical officers associated with the project, it is hoped to build up shortly a technically strong national s~aff. During the year the project succeeded in exceeding the targets set for the number of examinations. An average of aoout 80% of these examinations were carried out in the rural areas and an average of between 65% and 7CJfo were of children, pregnant women and women of child- bearing age arrl of their husbandS. A total of 440 012 blood tests were performed and 9.85%, or 43 384, were found reactive to the VnRL and Kahn tests used. There was little difference in the percentage of reactivity between the rural and urban areas, A total number of 354 952 patients were examined clinically and 19 096, or 5.37%, were diagnosed as suffering from s.yphilis; 10 455 cases of syphilis were reported treated. Five thousand two (5002) cases of gonorrhoea were also diagnosed and 4011 were treated; and 183 cases of other venereal diseases"including chancroid and lymphogranuloma venereum, were diagnosed and 126 were treated. Of the 15 III pregnant women examined, 902 or 5.96% were dia gnosed as syphilitic; 5141 or 8.79% of 58 452 women between 16 and 45 years of age examined were found syphilitic and 1091 or 3.2% of 33 760 patients under 18 years of age examined were found syphilitic. Maternal and Child Health, Taiwan (Aug, 1952 - Aim of the project. To provide an efficient maternal and child health service throughout the island; to train nursing and medic al personnel in all aspects of public health relating to mother and child; to improve health education. Assistance provided by WHO in period under review. A medical officer (from September 1954), a nurse educator (from Augus t 1952 to July 1955), and a nurse/midwifery educator (since March 1956), ) Probable duration of assistance. Five years. Work accomplished. WP/RIJ7/3 Page 51 The in-servic e training progra.mIlJ3 in maternal and child health for medical officers, nurse supervisors ani staff level nurse-midwives from health stations in Taichung County was completed by September 1955. TrainingootJrses for in-service staff from 50 health stations included in the expanded programme, and for students from Tainan School of Nursing, have continued. There has been an encouraging response to the three to four weeks refresher courses organized by the Government for private practising midwives in Taichung Country; and all the licensed private midwives in Taichung City have attended. It is hoped that these courses will lead to improved co-operation with the health stations and greater appreciation of the need for adequate prenatal supervision. Medical am nursing staff paid supervisory visits to a considerable number of health stations to assess and advise on the maternal. and child health work. The results indicate" the need to strengthen this aspect of the.programme. A school-health SlI'vey has bean completed by members of the project staff. Particular attention was given to the medical services and the health and nutrition- education programmes in schools. The Maternal and Child Health Advisory Committee has met regularly in Taipei. A sub-committee bas been working on proposals to establish a provincial institute of maternal and child health by amalgamating the Taipei Provincial Health Centre and the Maternal and Child Health project in Taichung. The facilities ani number of training professional staff available to provide maternity care have been studied by a sub- committee of the Medical Co-ordination Committee in connection with the midwifery training programme. WP/RC?/3 Page 52 China 6 TA Nursing Education, Taiwan (May 1952 - ) Aim of the project. To improve the standard of nursing education and the quality of nursing services, through the establishment, at the University Hospital in Taipei, of a university school of nursing. Assistance provided by WHO in period under review. A senior nurse educator as team leader (since November 1954), an instructor in general nursing (from May 1952- April 1956), a nursing instructor in obstetrics and paediatrics (from September 1952 to June 1956), a medical nur sing ins tructor (since May 1953), a surgical nursing instructor (since December 1954), two twelve- months fellowships in nursing and two fellowships of two years each in paediatric nursing and nursing education have been awarded. Probable duration of assistance. Until end of 1958. Work accomplished. The WHO nurse educator terminated her assignment at the Provincial School of Nur sing, Tainan, in April 1956. The school no longer requires full-time assistance from vVHO but guidance is continued through periodical consultations between the WHO team leader ani the Director of the School. The WHO team has continued to help in strengthening the quality of nursing education in the vocational school of nursing of th e National Taiwan University Hospital. The team leader made further contributions to planning an education on a national scale through membership of the Sub-Committee on Nursing and by conducting courses in ward administration and curriculum develop- ment for nurses from NTUH and other institutions. Through co-operation in the development of clinical facilities, through practical guidance of instructors and students and through participation in faculty planning, members of the WHO team have assisted in the preparation of facilities and personnel for the establishment of the University School of Nursing which is to open in September 1956. China 7 TA (ICA) WP/RC7/3 Page 53 Some of the most significant developments noted in the past year are greater competence, self-confidence and initiative on the part of counterpart personnel, con- siderable progress in clinical teaching with greater enthusiasm and participation by members of ward staffs, stuqy and revision of important nursing procedures, re-organization and better utilization of the library and recognition by patients of the good care given b,y students. The manuals on nursing arts and paediatric nursing were completed and the obstetric nursing manual was sent to the printers. Much time has been spent in planning the programme of the University school which is to commence with a four- year basic nursing-education programme. One of tre major problems is to select nurses with the appropriate education and experience to qualify, through fellowships study, for faculty positions in a university school. The establishmalt of a graduate nurse division in the National Taiwan University is an urgent need and is planned for 1957 as a first step in preparing for positions of greater responsibility. Graduates for such a prograIllTOO should be better fitted than the present group to profit by advanced study in othe r countrie s. WHO nurses were active in the group study of "Nurses - Their Education and Role in Health Programmes" prior to the Ninth World Health Assembly. This study had additional value through its relevance to the planning of a uc1versity programme. Malaria Eradication, Taiwan O~y 1952 - ) Aim of the project. To control malaria, and eventually to eradicate it, throughout the island, by use of insecticides with residual action. Assistance provided by WHO in period under review. An entomologist (from Ha.y 1952 until September 1955), a second entomologist (since April 1956), a six-week fellCMship to permit the Vice Director' of the Provincial Malaria Research Institute to undertake WP/FJJ7/3 Page 54 China 13 TA (UNICEF) a study tour in the Federation of Malaya, Ceylon and Thailand, and two nine-months fellowships for techni- cians to· stuqy medical zoology and medical entomology in Japan. Probable duration of assistance. Until 1958. Work accomplished. The 1955 :;:oesidual spraying operations covered over 5.6 million population. Surveys conducted in late 1955 show that malaria transmission has been stopped except in small localized areas which are now receiving careful attention. The 1956 operations included the spraying of the houses of over seven million people of "Which about half has been completed as of the end of June. Steps have been taken to organize a system of malaria surveillance with a view to detecting cases am immediately instituting remedial measures. 'The possible development of resistance of the vector species to insecticides has been closely observed by susceptibility tests. The project has served to pro- vide training'for malaria workers from other countries in the Region. Trachoma Mass Campaign, Taiwan (Oct. 1954 - ) Aim of the project. To control trachoma in a population of over two million school-children by a mass campaign; to organize services in s::hools and health stations, to combine prevention and treatment. This project follows the WHO/UNICEF-assisted trachoma pilot project which'commenced in September 1952 and ended in March 1953. Assistance provided by WHO in period under review. A short-tenn consultant visit in June-July 1956 to evaluate the progress made i a fellowship in the bacteriology am epidemiology of conjunctivitis ani trachoma, their prevention and treatment is also provided for in 1956, China 14 TA (1956 & 1957) (lCA) Probable duration of assistance. Extended until end of 1957. Wark accomplisred. WP/F£7/3 Page 55 The campaign, employing 438 teams, has examined I 583 074 school-children, 849 242 of whom were found to have trachoma and 290 836, other conjuncti- vitis. These were put under treatment in school with the aid of 1455 school principals and 26 826 school teachers who had been given the necessary training. Home treatment by older school-children of their familial contacts is being tried on a small scale. The results already available are encouraging. Although the epidemiology is not the same, considera- tion is being given to intermit tent treatment of con- juncti vi tis which m 5 proved to be economic al and successful in North Africa. UNICEF has a request for antibiotic ointment and sulfa drugs required for the continuation of the campaign in 1957. Erw:ironmental Sanitation, Taiwan (Oct. 1954 - ) Aim of the project. To survey the organization and functions of govern- mental agencies concerned with environmental sanitation; to evaluate major sanitation problems and establish priorities for work; to carry out a pilot project to dem::mstrate modern and economical sanitation procedures; to train personnel. Assistance provided by WHO in period under review. A public-sealth engineer (since January 1956), a four and a half months fellowship in environmental sani- tation far stuQy in Ceylon, Thailand, Singapore, Hong Kong, Japan, the Philippines, Hawaii, USA, and a twelve-month fellowship in public-health engineering for study in the US.\. WP/RC7/3 Page 56 China 17 R Probable duration of assistance. Until 1958. Work accomplished. The Government of China has initiated the Taiwan Institute of Environmental Sanitation which functions as an arm of the Taiwan Provincial Health Administra- tion. A WHO public-health engineer is the adviser to this institute which has initiated programmes for the study of problems of environmental sanitation in Taiwan. Programmes for rural and school sanitation are in pro- gress supported by government funds as well as assist- ance from ICA, the Joint Committee for Rural Recons- truction and the World Health Organization. A new training class for sanitarians has been planned and is in operation utilizing the facilities and staff of the Institute of Environmental Sanitation. Tuberculosis Control, Taiwan (May 1956 - ) Aim of the project. To expand the tuberculosis-control service and to integrate into it the BCG work already in operation; to explore new methods of control by chemotherapy of ambulant cases. Assistance provided by WHO in period under review. A medical officer (fram June 1956), one six-month fellowship in research methods as applied to chemo- therapy trials, and two twelve-month fellowships in tuberculosi~with special reference to public health, have been awarded. Probable dur ation of assistance. Until 1958 at least. Work accomplished. The control programme was carried on by the Govern- ment during the reporting year, and it was not until June tba t the WHO senior adviser was able to join the project. It is clearly too soon to give any indication as to his influence on the work. China 20 R WP/RC7/3 Page 57 A research trial dealing with chemotherapy of ambulant patients will begin very soon, following the fellow- ship in research methods mentioned above. Mental Health, Taiwan (Oct. 1955 - )- Aim of the project. To survey the reeds and the available facilities for mental ooalth; to draw up a programme with special anphasis on child guidance and community mental hospitals. Assistance provided by WHO in period under review. A consultant in October am November 1955; $600 worth of medical literature; two twelve-months fellowships, one in USA and one in Europe have been awarded. An inter-regional consultant on psychiatric nursing will visit Taiwan in August 1956. Probable duration of assistance. End of 1958. Work accomplished. The WHO short-term consultant found a small group in the Department of Neurology and Psychiatry at the National Taiwan University Medical School and Hospital which was doing excellent work. However, he felt that this group was attempting more research and teaching than it should. He advised the establishment of a children1 s psychiatric centre for the training of medical students and nurses. The consultant further recommended that WHO assist by providing fellowships in child psychiatry, clinical psychology and psychiatric nursing and by sending a short-term consultant to dis- cuss methods am guide research in the ecology of mental disorder. WP/RC7/3 Page 58 Federation of Malaya 1 TA Nursing Education~ Kuala Lumpur, Penang aqB lpoh (June 1950 - Aim of the project. To improve the standard of basic and graduate nursing education and t he quality of nursing services; to pre- pare local nurses for administrative and teaching posts; to adapt the nursing-education programme to local resources and needs; to develop a well-organized pro- gramme for midwives. Assistance provided by WHO in period under review. At Kuala Lumpur - a midwifery tutor (since July 1953), at Penang - a senior nurse educator (since August 1952), a male tutor in general nursing (since April 1953), a public-health nurse tutor (sinreJanuary 1953), a clinical nurse educator (since April 1956) and at lpoh, Perak, a midwifery nurse educator (since April 1956) • Probable duration of assistance. Until end of 1958. Work accomplished. Nursing education in Malaya is now centralized in the School of Nursing associated with Penang General Hos- pital. With the transfer of sister tutors from other centres, the staffing si tuation improved. The WHO team leader conducted a successful course of 15 weeks in ward administration in 1955 and a second course is to be given in 1956. Plans are being made for the WHO male nurse educator to spend more time in in-service education ani clinical work with male nurses. WHO has appointed a clinical nurse educator. Clinical instruc- tion is becoming more prominent in the programme for student nurses with increasing interest and participa- tion by ward sisters and staff nurses. A nursing- education committee was established and a successful workshop for ward and tutor sisters was held, both gi ving opportuni tie s f or co -opera ti ve planning. Counterparts have been allocated to work with WHO personnel in the clinical field. The second course for health visitors was held in Penang. MOre careful selection of students has made this class a more progressive study group Federation, of Malaya 9 R , (UNICEF) WP/RC7/3 Page 59 than the fir st. One counterpart has been appointed and when a second is assigned it will be possible to pay more attention to supervision of students in the field. In Selangor' the hospital training of midwives is well established. Division I students have received domi- ciliary experience with the MUnicipal Health Depart- ment of Kuala Lumpur and, following on survey visits to the rural area by the WHO midwifery tutor, a pro- gramme of domiciliary training for Division II students is being arranged. A survey of the needs for WHO assis- tance in midwifery tr::tining .has o.lso bee:n carri:;;d out in Malacca and Perak. A second WHO midwifery educator has been assigned to Perak. Plans have been made for the vi sit of a psychiatric nursing consultant and the appointment of a psychia- tric nurse educator. Rural Health Training Centre, Jitra, Kedah (Nov. 1954 - ) Aim of the project. To establish a training centre at Jitra for assistant health nurses, rural midwives, dispensers and sanitary 'overseers. Staff trained at Jitra will be assigned to 90 additional main health centres which the Government is building. These centres and sub-centres, in addition to their routine functions, will 'have special maternity and child welfare activities, including domiciliary mid- wifery, infant care and dental hygiene. Assistance provided by WHO in P3riod un1er review. A medical officer (from November 1954 - September 1956) and a public-health nurse (since November 1955). Probable duration of assis~ce. Until mid 1959. WP/RC7/'J Page 60 Work accomplished. This project, which has been to some extent frustrated by delays due to staff shortage and failure to complete the sub-centres in the training area, went into full swing in early January 1956 with the arrival of six trainee teams from six different States. Prior to the arrival of the teams, the WHO medical officer and public-health nurse with their counterparts had organized the training area. However, so great was the public demand for the use of the clinics and the inability of the Federal Government to find sufficient personnel for service that the WHO staff and their counterparts were overwhelmed with service demands to the detriment of their teaching responsibilities. This was totally unforeseen, as the size of the training area was delinated on the basis of previous returns from dispensaries, maternal and child health centres, and travelling dispensaries, maternal and child health centres, and travelling dispensaries which had given some service prior to the establishment of the health centre. Within three months, attendances at out- patient and maternal and child health clinics had increased sixfold, and patients from districts far outside the training area were queuing for attention early in the nig ht for the next morning I s clinic. In addition, a considerable amount of domiciliary mid- wifery was being done, and school health, yaws, malaria and environmental sanitation programmes had been developed. This is an example of what happens when a medical ser- vice which pays attention to local customs and beliefs is established in rural areas where there ha s been less intimate service given previously. With the arrival of the teams, it was necessary to curtail serv:ices strictly to the training area. With the opening of sub-centres, the pressure will fall still further. In the second half of the year under review six teams bad been tr.aUled, .and six more are now in training. Federation of Malaya 14 TA Fiji 1 R (UNICEF) Hospital Administrati on (May 1956 - Aim of the project. WP/RJ:,7/3 Page 61 ) To review the hospital administration S,Ystem; to devise a suitable scheme for the training of lay hospital admi- nistrators bearing in mind the facilities available in the Federation and overseas. Assistance provided by WHO in period under review. A hospital administrator since May 1956. Probable duration of assistance. Until 1959. Work accomplished. The expert is at present working at the first phase of the project visiting hospitals and surveying the whole situation. Furtrer develop~nts must await the results of this survey. Yaws Control Feb. 1956 - (Phase I: Nov. 1954 - June 1955; ) Aim of the project. To reduce the prevalence of yaws by mass examination and treatment with penicillin; ultimately to eliminate the disease as a public-health problem; to train local personnel in the diagnosis, therapy and epidemiology of yaws. Assistance provided by WHO in period under review. The international yaws team consisting of a medical officer, a serologist and a male nurse/administrator returned to Fiji in February 1956 and departed for Honiara in May 1956. Probable duration of assistance. Through 1958. WP/RC7/3 Page 62 Fiji 2 R Work accomplished. The WHO team of aDEdical officer and a serologist worked with the national staff consisting of a part- time health officer, and a health sister, 6 assistant medical practitioners (AMP) and 5 assistant nurses (AN) and auxiliary staff to establish this project starting in November 1954. Between February and May 1955, the clinical and sero- logic survey of the pilot area, Savusavuwas completed and. the population of 5362 was examined. Four thousand two hundred seventy-six (4276) blood samples were te sted - the inf ant s were not blood tested. Treat- DEnt with penicillin was given to the total population with the exception of 50% of the serologically latent cases; 3476 patients received penicillin. The mass campaign, in which treatment with penicillin was given to the total population of Fijians and sig- nificant groups of Indians and other races, commenced in June 1955. As of April 1956, 103 352 people had been examined and a total of 28 130 (27.2%) were found to have active yaws, of which 6(1]6 were infectious yaws cases .. The resurvey of the pilot project was commenced in February 1956, on the return of the WHO team to Fiji, from vlestern Samoa. As of April 1956, 4700 people had been examined and 4389 blood tests had been carried out. The analysis of the data from the pro- ject has not been completed, Central Medical School, Suva (Feb. 1955 - ) Aim of the project. To train assistant medical practitioners for govern- ment servic e in Fiji and adjacent territories, and to strengthen tl:e staff of the Central Medical School. Assistance provided by WHO in period under review. One lecturer in biology and one in physiology and related sciences (from February 1955); a three-year fellowship to train a medical student for a junior lectureship in physiology; and supplies and equip- ment. Probable duration of assistance. Six years. Work accomplished. WP/RC?/3 Page 63 The success of the project, which is now in its second academic year, can well be assessed by the fact that some senior students and some of those already graduated have expressed their desire to attend the courses in physiology and biology as they realized how much they themselves had missed. It is gratifying to record the remarkable effect which the organization of well-equipped and well-staffed Departments of Physiology and Biology has had on the whole medical school. Outside technical achievements, the lecturers are also to be connnended on tha effect of their example in the social and recreational life of the school. This has been'the subject of special commendation by the Principal. It is also worthy of record that the results of the professional examina- tions in physiology and biology were good. They were assessed by external examiners in physiology (and by the Departmen t of Zoology in the University of Otago). It is considered that 25% of the students were up to good university medical school standard and that with better high school and premedical teaching the majority would also reach that standard. Approximately 75% of the students passed. Gold medals were awarded to the best ci:m:lidate in each discipline. Both departrrent s are now adequately equipped and are entirely suitable for undergraduate teaching. The preparation of bio- logical specimens for demonstration is well advanced. A WHO fellowship has been awarded in physiology, and the Fijian holder is in Otago University studying for his Bachelor of Science. He is working courageously against a poor rna. thematical background, but is unde- terred. It is of interest to report that within three weeks of arrival, he represented his college in the University Boxing Champioship and in the final for the heavyweight, knocked out his opponent in twenty seconds to win the event. A prospective fellow in biology for 1957 is studying under the WHO lecturer. The Government has sent a Fijian student to the University of Otago to study for his Bachelor of Scien ce in Chemistry. W P/RC 7/3 Page 64 Hong Kong 4 TA (UNICEF) The new medical school was occupied early in 1955. Outside the actual sphere of WHO responsibility, there has been a considerable improvement in the staffing of the school with a corresponding improve- ment in the curriculum. A whole-time lecturer in chemistry from a university is under recruitment, and there are whole-time lecturers in phYSics and anatomy. In the very near future the arrival of specialist officers in radiology, psychiatry, ophthalmology and anaesthetics will strengthen the staff in these disciplines. Maternal and Child Health, Hong Kong (April 1953 - March 1956) Aim of the project. To demonstrate modern maternal and child health ser- vices suitable to Hong Kong; to strengthen infant- welfare and school-health programmes and domiciliary midwifery services; to provide instruction in child health for school teachers and parents, health educa- tion and refresher courses for midwives; to improve training in paediatrics and promote post-graduate education in child health. Assistance provided by WHO in period under review. A short-term consultant in child guidance (from November 1955 to January 1956), two nurse educators (from March and June 1954 respectively until March 1956), and a twelve-month fellowship to study health education in the USA. Work accomplished. During the first year of the project, closer contacts were established between too staff of the Medical Department and other government departments, and national and voluntary agencies concerned with dif- ferent aspects of community and family welfare. A study was also made of the administration and organization of maternal and child health services in the Colony. This included an analysis of the case-loads carried by maternal and child health staff and government district midwives, and the collection of data on the maternity-care services available. This survey demonstrated an urgent WP/RC7/3 Page 65 need for a wider distribution of maternal and child health services in the Colony. By the end of 1953, prenatal and/or infant welfare clinics had been started in nine dispensaries where none had previously existed. In the second phase of the project, the WHO senior nur se and he r counterpart assi sted in improving the organization and quality of maternal and child health services and in developing an active health-education programme at two centres, Lee Kee Dispensar.1 and Tsun Wan. A closer working relationship now exists with the tuberculosis and venereal-disease services, and home visiting has been successfully established and is well received. Pre- and pos t-natal and infant welfare clinics are held regularly, and a ver.1 active health-education programme is being carried out with an excellent response from the mothers. A play group for pre-school children (2-6 years), who come to one infant welfare clinic with their mothers was started wi th the help of voluntary workers. Training of in- service nursing and midwifery staff has been carried. on. Demonstration school-health services have been established in seven selected schools where regular physical examination of all children is provided with treatment and follow up of referrals. Teams of pupils have also been trained in First Aid and given simple equipment. An outline for a new syllabus has been drawn up for use by the teachers who are responsible for health education in the schools. In the school curriculum, regular periods are now allocated for health teaching. The interest of the pupils is evident am. the co-opera- tion and enthusiasm shown by the headmaster, teachers ani parents in this programme is remarkable. In one school, a feeding programme has been started and is run by a parents' ~ssociation. In-service training has been given to school-health nurses. Students from the Health Visitors training course come in small groups to observe the programme. Courses in hygiene are being given to teachers- in-training by the health educator on the staff of the Department of Education. A health education planning committee has been formed and meets regularly. WP/RC7/3 Page 66 Japan 4 R Japan 10 TA National Institute of Mental Health, Japan (June 1953 - ) Aim of the project. To survey the needs and available facilities for health and to draw up a mental-health programme; carry out research and to train professional and auxiliary personnel. mental to Assistanc e provided by WHO ill period under review. A six-month fellowship in Europe has been awarded, and supplies to the amount of $1640 have been provided.in 1955. Probable duration of assistance. Extended to 1958. Work accomplished. WHO equipment, supplies and medical literature and fellowships helped to strengthen the National Insti- tute of Mental Health, which is mainly a research and training unit which offers consultation services. With this as a nucleus, the Government plans to establish 122 child guidance clinics at strategic places throughout the country. Assistance to Institute of Public Health March 1955 - Aim of the project. To strengthen the various Departments, particularly those of Epidemiology, Nursing, Medical Social Ser- vice and Environmental Sanitation, including Water Pollution, for the post-graduate training of health personnel. Assis tance provided by WHO in pariod under review. A consultant in mocical social service (from June to July 1956). Japan 11 TA WP/RC7/3 Page 67 Probable duration of assistance. End of 1958. Work accomplished. In the past, a short-term consultant on epidemiology and fellowships in epidemiology and medical social servic e have been pr ovid ed. During the next few months, a WHO short-term consultant on water pollution will visit the Institute. Overseas training programmes on water pollution and in the training of sanitarians are being finalized and the required fellowships will soon be awarded. The WHO consultants, in addition to working at the Institute, travel extensively in Japan, to exchange infonna tion and give advice. Their services are not confined only to the Institute of Public Health. The assistance given to the Nursing Department of the Institute is reported in another section of this report. Environmmtal Sanitation, Japan (Aug. 1955 - ) Aim of the project. To study economic and hygienic means of disposing of night-soil and other organic refuse; to operate a pilot composting plant with a view to the eventual establishment'of a full-scale prototype rapid com- posting plant. Assistance provided by WHO in period under review. A public-health engineering consultant in August- September 1955; supplies and equipment; and two twelve-month fellowships in environmental sanita- tion for study in the United Statos h;:vo 'OOen awarded. Probable duration of assistance. Through 1956. WP/RC?/3 Page 68 Japan 14 R Work accomplished. Pilot plant operations~r compo sting of organic refuse and night-soil have been successfully carried out in 1955 to 1956 in Kobe. Japan. Based on the experience gained in operations of this pilot plant, a prototype full-scale compo sting plant has been designed and is expected to be in operation in the middle of 1956. It has been found to be technically possible to com- post night-soil and refuse which are two of the major environmental sanitation problems in Japan. The economy of the process will be studied during the operation of the full-scale plant and based on the results of these observations recommendations were made to too Goverrunent of Japan as to the feasibility and economy of this type of refuse and night-soil disposal and utilization for agricultural purposes. Nursing Education, Tokyo (Aug. 1955 - ) Aim of too project. To strengthen basic nursing, midwifery and public- health nursing education; to develop a post-graduate educational programme at the Institute of Public Health, Tokyo; to provide a qualified faculty for the post-graduate education centre. Assistance provided by WHO in period under review. A nurse educator (from August 1955), and a t~elve month fellowship to study nursing in the United Stotos has bu~n awarded. Probable duration of assistance. Until 1958. Work accomplished. The WHO Duree 9ducator was invited to make numerous field visits to different parts of Japan, thus being able to obtain an excellent understanding of the nursing problems of the country and of the educa- tional needs of nursing students at the Institute of Public Health. During these visits her advice was sought by nursing personnel at schools and Laos 2 TA WP/RC7/3 Page 69 hospitals visited. In addition, she participated in two to three-day seminars in eight regions, and con- ducted short courses in curriculum planning and prin- ciples of nursing education for nursing leaders in Tokyo, thus extending her assistance in nursing education to many groups. Her main activities at the Institute have been to assist the faculty in curriculum planningl through a course of lectures ani by participation in faculty meetings; to guide faculty members in planning field practice far students, including planning with affi- liating institutions; and to assist in the selection and. preparation of candidates for WHO fellowships. Working relationships in the faculty group have been excellent. The contribution of the WHO nurse educator was limited until adequate assistance with translation was availabl e. The faculty is anxious to improve the supervi sion of students during periods of field experience and teaching practice. This will be easier to achieve when the number of well-prepared instructors is increased. Yaws Control, Thakhet, Savannakhet, Saravane and Pakse (Jan. 1953 - ) Aim of the project. To survey the yaws situation; to train local personnel in the diagnosis and treatment of yaws; to carry out a mass campaign through health education, house-to- hous e case-finding and treatment of all accessible clinical cases and contact~so as to reduce incidence to a level at which the public-health programme can maintain control. Assistance provided by WHO in period under review. A medical officer (from August 1955). Probable duration of assistance. End of 1957. WP/RC7/3 Page 70 Work accomplished. Field work in this project was started in April 1953 but progress was hindered by the disturbed conditions which prevailed for some time afterwards. However, by the end of 1955 the initial treatment survey of Savannakhet province had been completed and a resurvey of 93 selected village~in which a high prevalence of yaws had been found at the initial survey, had been carded out as a check on the results of the initial survey_ A total number of 167 352 people, or 94.36% of the population of the 1016 villages of the province, were examined at the initial survey and 8575 cases of active yaws were foun~including 508 infectious cases. Four hundred twenty (420) of the infectious cases (84%) were in children under 16 years of age, The average prevalence of yaws found varied from 11% in Phalane district to 1.59% in Tchepone district. On the other hand, at the resurveys carried out in the 93 selected villages, it was found that all the infectious cases previously treated were cured, that 82.5% of the total cases treated were cured, 12.3% were improved and 5.1% were not improved. The cases resistant to treatment were of hyperkeratosis or joint pains - doubtful cases of yaws. Further, whereas at the initial survey the prevalence of yaws was found to be 5.12% in these villages, at the resurvey carried out nine months to 30 months later, the prevalence was found to be 0.43%. All cases and their significant contacts were treated. A parallel re- survey of eight villages in Tchepone with an initial prevalence of 1.59% of yaws revealed only one case of non-infectious yaws. It may be conCluded that the district was virtually cleared of yaws. It is consi- dered that the results of the campaign in Savannakhet province have been highly successful. At the end of 1955, the field teams commenced the initial treatment survey of Saravane and Pakse provinces to the south-east of Savannakhet province. A total of 41 190 people were examined and 1969 cases of active yaws were found including 108 cases of infectious yaws. The average prevalence of yaws found in Saravane and of infectious yaws was low. For th e past year, a total of 73 108 people were examined and a total of 2626 cases of active yaws were di agnosed, incl uding 131 cases of infectious yaws. North Borneo 5 TA (UNICEF) North Borneo 6 TA Malaria Control, Keningau, North Borneo (July 1955 - ) Aim of the project. WP/RC7/3 Page 71 To study the malaria situation in the country; to train local personnel and to carry out a control pro- gramme. A ssi stance provided by WHO in period under 'review. A malariologist and an entomologist (from July 1955). Probable duration of assistance. Until 1959. Work accomplished. The preliminary survey ha s been completed and the area of operations has been delineated. The first residual spraying has been started with the object of covering a population of over 53 000 in 1956. Studies on the bionomics of the vector species have been made and the observations indicate favourable results with residual insecticides. Training of local staff in blood eXamination, entomological techniques and spraying operations was emphasized. and Sandakan Aim of the project. To establish a programme of basic nursing education, including public-health nursing and midwifery. Assistance provided by WHO in period under review. Two nurse educators (from September 1953 and July 1954 to June and September 1955 respectively). Work accomplished. On the termination of WHO assistance in September 1955, twenty-three students were enrolled in the S·chool of Nursing in Sandakan, 16 in their first WP/RC7/3 Page 72 North Borneo 8 TA year and 7 in their second year of studies. The future of the programme was uncertain as no sister tutor had been recruited to replace the WHO nurse educators. Experience in this project demonstrated that people of limited educational background can, through patient teaching and a curriculum suited to t heir needs, be· prepared to accept responsible positions in nursing. The WHO nurses observed the growth of a greater sense of social and professional responsibility and recog- nition of the need for improved health services. It is expected that, despite the interruption in the programme, the students of the School of Nursing will become some of the leaders of the future. Envirorunental Sanitation (Dec. 1953 - ) Aim of the project. To study environmental sanitation problems, particularly collection and disposal of sewage in Jesselton, Labuan, Kudat, Tawau, Saniakan, Papar and Beaufort, with a view to carrying out appropriate measures. Assistance provided by WHO in period under review. Two public-health engineers (from July and November 1954 respectively). Probable duration of assistance. Through 1958. Work accomplisred. Detailed studies have been made of the problems of disposal of human excreta in t he urban communi ties mentioned above. Field surveys, detailed designs, plans and specifications have been completed for four of the communities am similar work will have been·completed on the remaining three by the end of 1956. The Goverrunent is committed to constructing and operating the water~borne sewerage systems which have been designed for these communities and construction has been initiated on one of the systems. A great deal of valuable information and experience Philippines 9 TA WP/RC7/'J Page 73 has been obtainad from tha design of small water- borne sewerage systems for communities up to 40 000 population in tropical areas. This information will be made available in published form at the completion of the project. The WHO public-haalth engineers assigned to the urban pro ject have also assisted the Government in a pilot scheme for improvement of rural sanitation. This assistance has included the design of o. series of simple and economical sanitary structures such as wells and latrines and the field installation of some of these facilities. Bilharziasis Control, Leyte (June 1952 - ) Aim of the project. To determine the most effective and economical means of controlling bilharziasis; to train local profes- sional and auxiliary personnel; to conduct studies on the human, domestic-animal and snail hosts of Schistosoma japonicum and on the parasite itself; to make an epidemiological study of the disease in a highly epidemic area; to plan a control programme. Assistance provided by WHO in ;e::riod under review. An epidemiologist (from August 1954), a zoologist (from March 1954 until June 1956), a public-health engineer (from October 1952), supplies and equipment, and a twelve-month fellowship to permit the national epidemiologist to study public health in the United States, majoring in epidemiology. Probable duration of assistance. Until end of 1959. Work accomplished. The year under review saw the first half of this project result in a clarification of ideas and the planning for of a large-scale control programme against snail breeding places for the next stage. It was tha hope at the start of the project that some weak point would be found in the life history WP/RC7/3 Page 74 of the snail that would pennit a relatively inexpensive attack to be made upon it. No such well-defined target has appeared, but certain facts about the biology of oncomelania quadrasi have been found which have pointed the way tCMard possible methods to be attempted towards its eradication. Experimental control measures have been listed, costs estimated and those of promise wefted into a mosaic of methods to be applied over a large area with a population of 15 000 people in order to determine the effect on the social, economic and healthy life of the people. Measures have been sought which will result in other 'benefits than mere snail control. Land reclamation, improved land; increased agricultural production have been the aim. Removal of vegetation, drainage, filling, flooding, fish ponding and improved rice farming with eradication of snails have all proved successful in small scale tests. Least successful has been the attempt to get proper usage by the people of latrines, in'spite of intensive community effort. Tests have shown, however, that even partial use can result in a lowered rate of infection in adjacent snail colonies. The services of a social anthropologist were obtained to try to understand the reluctance of the people. Her ideas will be given trial. It is irrleed fair to say as was found in Italy that "malaria nees before the plough" so will schistosomiasis in the Philippines in the larger endemic areas before the plough and the bulldozer if the large-scale experiment in land bonification proves to be economically feasible. Of equal importance to the control of schistosomiasis h3. s been the work of the team to establish the burden of illness in the community caused by schistosomiasis and the economic cost, relatively to the multiple aetiology of disease in the area especially other common helminthic infections and malnutrition. Studies on this aspect are continuing. The greatest problems facing the team are how to use tbe folk aetiology of disease to make acceptable scien ti fie ideas which conflict with it, to obtain communi ty co.-operation in land improvement, and to obtain the relatively large amount of money which will be needed for the large-scale experiment to carry it through in a short period of time SO that evaluation can be made before the end of the project. Philippines 12 TA (Johns Hopkins University) (Roc kefeller Foundation) Manila Aim of the project. WP/RC7/3 Page 75 of the Phili To provide further training to the faculty of the Institute of Hygiene by an exchange programme between mmbers· of the teaching staff of the Institute and the Johns Hopkins University School of HYgiene and Pub lic Heal th • Assistarce provided by WHO in period under review. A short-term consultant in public-health nursing (from June to September 1955), a lecturer in hospital administration and epidemiology (from October 1955 until September 1956), a consultant in public-health nursing (from May 1956), a short-term consultant in biostatistics methods (from June 1956). Probable duration of assistarce. Six years. Work accomplished. This exchange programme which has been functioning since 1953 continued satisfactorily during the year, except that for insurmountable reasons, Johns Hopkins University School of HYgiene and Public Health was not able to send two associate professors for the academic year. Instead of one short-term consultant and an associate professor of public-health nursing, it was possible to send only two short-term consultants; in addition, the associate professor in e'pidemiology and hospital administration remained only for half a year. Too short-term consultant in biostatistics had just arrived before the end of the year under review. Nevertheless, good work was done and the consultants in public ... health nursing have been able to plan and consolidate the training of public-health nurses in the Institute. The associate professor in hospital administration and epidemiology was successful in developing hospital audit survey methods which aroused considerable interest. In the field of epidemiology, however, many investigations which he had started, had to be abandoned because of the lack of a counter- part, the heavy teaching load of the institute staff WP/RC7/3 Page 76 Philippines 29 TA (UNICEF) and the lack of satisfactory facilities to investigate epidemiological problems in the field. The latter difficulty will be reduced when the new Regional Public Health Laboratories have had time to get organized. His final report will have many valuable recommendations to improve epidemiological investiga- tions and the teaching curriculum. Midwifery Training, :hiliPyines (Caloocan, Cebu, Manila) (Oct. 1953 Aim of the project. To study existing midwifery services and training facilities; to develop a well-organized training programme for midwives; to train village midwives (hilots); to make a study of maternity-nursing needs am resources; to formulate a midwifery practice act. Assistance provided by WHO in period under review. A nurse educator (midwifery) (from April 1955), and two twelve-month fellowships, one for study in the United Kingdom and the other in New Zealand. Probable duration of assistance. Until end of 1957. Work accomplished. The programme for midwifery training of nurse super- visors, nurses and midwives from puericulture centres and rural health units is continuing wi1Jh four out of five Regional Training Centres participating. A reries of one-day seminars was held for puericulture centre supervisors. The staff of the Caloocan Training Centre ha s revi sed the cent ent of it sin-service midwifery course. A "Maternity Service Manual" has been compiled am the first revision made. "Criteria for Selection of Hilots" and the "Instructors I Guide for Hilot Training" have also been revised. Assistance was given by staff of the Caloocan Training Centre in writing the procedures of the rna ternal and child health section of the manual for public-health nurses prepared by the Division of Nursing. WP/RC7/3 Page 77 The training of hilots also continues and supervl.sl.on of hilots who have completed the course and received a UNICEF delivery ki t is now a regular activity of the puericulture centre nurse or midwife. During the past year, the WHO nurse-midwife consultant ta s devoted more time than formerly to assistance in basic midwife~ education. The Cebu School of Mid- wifery, after being closed for several years, re- opened in October 1955 with the admission of 40 students. The WHO consultant paid three visits to Cebu, to assist with preparation for the opening of the school, setting up the educational programme and developing experience fields in hospital, prenatal clinic and domiciliary delivery service. The con- sultant has also met wi tb the faculty of tba Manila School of Midwife~, to advise on implementation of the new curriculum and stUdent experience in the prenatal clinic and domiciliary care. Students now spend six weeks in the domiciliary obstetric service of the Manila Health Department. A WHO fellowship has been awarded to a faculty member from each of trese two midwifery schools. A committee was set up to revise the curriculum for governnent schools of midwifery and the new curriculum was approved. The maternal and child health sub- committee is obtaining statistical information which will indicate trends in attendance at delivery and the workload of professional personnel in maternal and child health services. There ms been evidence of a growing interest in the establishment of a midwife~ training programme for nurses but so far no concrete plans for this have been made. Legislation has not yet been reviewed but is to be studied-by the maternal and child health sub-c omrni t tee. The WHO consultant served on a committee which prepared a plan for appointment and training of supervisors of nurses and midwives in rural health units, which has been presented to the Director of the Bureau of Health. WP/RC7/3 Page 7S Philippines 43 R Environmental Sanitation (June 1955 - ) Aim of the project. To co-ordinate and strengthen activities designed to improve environmental sanitation. Assistance provided by WHO in period under review. A public~health engineer (from June 1955), and a four-month fellowship to permit the Deputy Director . of the Community IiJater Supply Project to attend the Environmental Sanitation Seminar in Ceylon and observe rTBthods and techniques in environmental sanitation in countries in the South-East Asia and Western Pacific Regions. Probable duration of 8eeistance. Through 1958. Work accomplish ed. The chief accomplishment on this project, aside from the technical assistance given in the day-to-day activities of the Division of Sanitation in the Department of Healt h, has been to stimulate and advise on the production of a long-range environ- ment al sanitation plan for the Philippines. This plan is now approaching final form and will be used as a basic document by the Government in planning futur e wor k in t he field. The Division of Sanitation has been strengthened by the addition of full-time sanitary engineers on its staff, and the training of sanitary engineers in public health in the Institute of Hygiene of the University of the Philippine s has been materially assisted by the part-time assignment of the WHO public-health engineer to that institution. A proposed plan for a gradua te cour se in public- health engineering has been approved by several administrative bodies within the University of tre Philippines and it is expected that this course, which will lead to the degree of Master of Public Health Engi. neering, will be ins ti tuted in 1957. Philippines 47 TA Sarawak 5 TA WP/RC7/3 Page 79 Medical Education (Nov, 1955 - Feb. 1956: Phase I) Aim of the project. To make a study of the facilities and system in three private medical schools with a view to determining tre type of assistance required to strengthen teaching in the basic medical sciences. Assistance provided by WHO in period under review. A consultant in medical education from November 1955 to February 1956. Probable duration of assistance. Phase I : Phase II: four months / will not be known until a request for assistance has been received and studied. Work accomplished. A consultant in medical education, Dr. J ,A. Curran, Associate Executive Dean of the Medical School for Medical Education, State University of New York, visited the Philippines for four months during which time he studied the problems facing private medical schools in the Philippines. He studied particularly the medical schools of the University of Santo Tomas, the Far Eastern University, and the Manila Central University. His report is unier study by the Government and the three private medical schools. His report, which is too voluminous to summarize here, covers the whole field of medical education and administration of the schools and should form a valuable reference to those responsible for tre direction of these schools. Malaria Pilot Project, Sarawak (July 1952 - ) Aim of the project. To control malaria by indoor spraying with residual insecticides in an experimental area to determine the efficacity of this control method in the country; to train professional auxiliary and ancillar,y person- nel for malari a control throughout t re country. WP!RC7!3 Page 80 Singapore 2 TA Assistance provided by WHO in period under review. Two malariologist (one from February and the other from May 1956), and an entomologist (from December 1953) • Probable duration of assistance. Until 1960. vJork accomplished. The results of the first dieldrin spraying operations in the First Division have been obtained, indicating satisfactory results with either dieldrin at a dose of 0.5gram per square metre or DDT at :2 grams per . square metre once a year. The studies also indicate tha t farm huts have to be sprayed unless it can be shown that transmission does not occur in them. Plans have been made for the expansion of operations, and as of the end of June, the houses of more than 40 000 people have been sprayed. Training of local personnel was continued. University of Malaya (Sept. 1952 - ) Aim of the project. To develop the teaching of preventive and social IlEdicine in the Faculty of Medicine of the University; to establish a first-class post-graduate school of public health. A shorirterm consultant in IlEdi.cal social sciences to assist the Government in organizing a training course for almorers res been added in 1956. Assistance provided by \-ffiO in period un:l.er review. A lecturer in physiology (fron June 1953 to December 1955), and a short~term consultant for three months to organize a training course for almoners (from April 1956).. Probable duration of assistance .• Six years. Singapore 4 R (UNICEF) WP/RC7/3 Page 81 Work accomplished. During the year under review, assistance to this project was confined to the extension of tre services of the lecturer in applied physiology to allow him to teach his subject during the first term of tre diploma course in public health in the academic year 1955-1956. This extension was granted as his counter- part was overseas on a WHO fellovTship stud;ying applied physiology in the University of Edinburgh. Another fellowship for a staff member of the Faculty of Medicine to study virology was granted during the year. In addition, three fellowships, two !rom Hong Kong 'lnd Ono from th:; Philippines to attend the course, were awarded. Early in 1956 a WHO consultant in the training of almoners, Miss Helen Rees, Director of the Institute of Almoners, England, visited the University and . advised on the setting up of a training course at the request of tte University and Government. Her report is awaited. Urban Health Centre, Singapore (Jan. 1956 - ) Aim of the project. (a) 'I!o provide maternal and child health, school health, school dental and health education services to a population of approximately 125 000 living in the vicinity of t he Centre, which will serve (b) as a training field for undergraduate medical and post- graduate public-health students of the University_of Malaya, including students from other countries in the Region; also for the training of realth visitors, health inspectors and other ancillar,y personnel; (c) the development and organization of training courses for the categories mentioned in (b). Assistance provided by WHO in period under review. A senior nurse educator (from January 1956) and a short-term public-health nurse consultant (from January to March 1956); two twelve-month fellow- ships in child psychology and one twelve-month fellowship in psychiatric social work for study in the United Kingdom. WP/RC7/3 Page S2 Probable duration of assistance. Until end of 1958. Work accomplished. A public-health nurse consultant, Miss E.J. Merry, Superintendent of the Qteen1s Institute of District Nur sing, England, visited Singapore for three months in early 1956 to stud;y ani consolidate plans for the training of public-health nurses. Her report is under consideration ty the Government. In her valuable report Mi ss Merry recommended three training programmes - (a) a public-health nursing course; (b) an assistant health nurses course combining general nursing, public health, home nursing and midwifery; (c) a short public-health course of six weeks for assistant nurse-midwives entering the health service. She also recommended the establishment of a "Joint Board of Public Health Nur sing Studies ll between the Government, the University of Malaya" and the local authorities to be responsible for the total direction of the public ... heal th nursing course, and she gave counsel as to the form of training and field experience needed for the courses am. the duties of each category of trainee. In her report she reviewed tlB existing public-health service, the connnunity needs of the islarrl with special reference to midwifery, infant ~nd'child welfare, school-children and home nursing care. She detailed the type and number of nurses ,and midwives needed to meet these needs and she strongly recommended the establishment of a district nursing service. A WHO senior public-health nurse educator was re- cruited for this project at the beginning of 1956 ani was with Miss Merry during her consultantship. She has been preparing for the assistant health course which will begin when the Urban Health Centre opens in September. During the year, three fellowships in child psychiatry, child psychology ani psychiatric social work for the personnel to carry out Singapore 8 TA WP/RC?/3 Page 83 studies of child development in the three main races of Singapore (which Will be based on the Urban Health Centre) were awarded. Nursing Education, Singapore (June 1952 - ) Aim of the project. To improve the standard of nursing education am the quality of nursing services and health teaching; to prepare local nurses for administrative and teaching posts; to adapt the nursing-education programme to local needs and resources; to develop an organized midwife~ teaching programme; to develop a teaching centre for domiciliary exp erience for pupil· midwives; to raise the standard of midwife~ practice. Assistance provided by WHO in period under review. A senior nurse educator (from June 1953 to December 1955, transferred to Singapore 4 project in January 1956), and two nurse educators in general nursing (from November 1954 and August 1955 respectively). Probable duration of assistance. Until end of 1959. Work accomplished. The midwifery training phase of the nursing-education project officially terminated with the transfer of the WHO nurse educator to the Urban Health Centre Project in Janua~ 1956. However, supervision will be maintained until the domiciliary delivery service has completed its first year. This service which commenced in September 1955 has functioned smoothly and expanded steadily, now providing experience for medical as well as midwifery stUdents. With the completion of this final stage in the development of the programme, midwifery education in Singapore is now well organized and established. Over the four-year period, WHO has assisted in basic hospital training, in-service and pre-service training and the development of a domici- liary after-care and delivery service. WP/RC?/3 Page 84 Viet Nam 3 TA (UNICEF) The nursing-education programme at tm General Hospi- tal h9.s continued to be somewhat hampered by changes in personnel, shortages of teaching staff, large classes of students and delay in the recruitment of a third WHO nurse educator. Courses in ward adminis- tration and nursing arts for staff nurses were given b:9' the WHO nur se educator s between June and December 1955. By dividing the staff nurses into four groups all were given the opportunity to attend these classes. Tm WHO staff members were also able to spend some time with the student nurses in the wards for a brief period at the end of the year when the classroom teac hing load was lighter than us ual. Due to the above-mentioned difficulties, however, there has been less emphasis than originally intended on in- service education of staff nurses and clinical instruction for student nurses. During the visit of the Nursing Adviser, preliminary plans were made for the appointJnent of a WHO nurse educator to assist with the training of psychiatric nurses at the Woodbridge Mental Hospital. A psychia- tric nursing consultant is visiting Singapore to give further advice on this new aspect of the programme. Maternal and Child Health, Saigon, Hue and Dalat (Dec. 1954 - ) Aim of the project. To meet needs in preventive and curative paediatrics by reorganization of the three clinics in Saigon- Cholon; to develop a programme of maternal and child health servic es by: setting up prenatal and post- natal consultative services; establishing maternal and child health centres in the three Saigon clinics, in a hospital at Hue and in one at Dalat; introducing progressively a system of domiciliary health Visiting. Assistance provided by WHO in perioo under review. A medical officer (from December 1954) and a nurse educator (from February 1955); two six-month fellowships in maternal and child health for study in Europe and two twelve-month fellowships in paedia tric nursing for study in New Zealand. Viet Nam 4 (UNICEF) Probable duration of assistance. Five years. Work accomplishe d. WP/RC7/3 Page 85 The out-patient department of the new Children's Hospital in Saigon opened late in 1955. Since that time attendances have increased steadily until they now total over 60 000 a month. Two wards for infants admitted their first patients in May 1956 and others are expected to open shortly. Pre ... service (post- graduate) training courses have been and are being given to some nursing staff as part of this project, and to others under the Internation Co-operation Administration programme. Child health consultations have been started at the Hospital as a first step towards a comprehensive child-health service, which will also include home-visiting. The na. ternal am child heal til programme in other centres in Saigon has continued, but shortage of trained staff is hampering development. In Dalat, paediatric consultation clinics have con- tinued at the hospital centre. The facilities are being extended by the addition of a new pavilion to tlE na. terni ty secti on, which wi 11 provide room for prenatal consultations. The maternal and child health programme in Hue has made a promising start. Daily paediatric consultations have been organized at the hospital since the beginning of the year, and plans have been made to begin prenatal and child-heal th consultations in the near future. Rural midwives are being gi.ven a six-month hospital training course. BCG Vaccination (Jan. 1954 - ) Aim of the project. To organize and carry out a mass BCG vaccination programme as a means of affording immediate pro- tection to an important section of the community; to lay the foundations far the establishment and expansion of a national BCG vaccination service as part of the tuberculosis-control service. WP!RC7!3 Page 86 Western Samoa 1 R (UNICEF) riod under review. A madica1 officer (jointly with Cambodia 6, from January 1954 to December 1955) and a BCG nurse (from March 1954 to June 1956). Probable duration of assistance. vJHO UNICEF: To 30 June 1956 Throughout 1957 Work accomplished. Despite a number of handicaps and difficulties, tID campaign continued throughout the year with four trained teams (at times re-arranged into three). At 19 May 1956, the cumulative totals were: tested 586 662 vaccina ted: 199 115 The number of tests, after 27 months of total working, was about 170 000 below the expected figure, and the new criterion for vaccination has not been put into effect. Yaws Control (Phase I: June 1955-Feb. 1956) Aim of the pro ject. To reduc e the incidence of yaws in Western Samoa to a minimum by means of mass treatment with penicillin and, if possible, to eliminate too disease as a public -health pro blcm; to trai n loc al pro fes si onal and auxiliary medical personnel in the diagnosis, modern the rapy and epidemiology of yaws and. in the techniques of present-day yaws control methods. Assistance provided by "'THO in period under review. The international yaws team consisting of a sero- logist (from June to September 1955), a medical officer (from July 1955), a second serologist (who replaced the first one terminated in September 1955, from November 1955) and a male nurse-adminis- trator (from December 1955), returned to Fiji in February 1956. Probable duration of assistance. Until 1957. Work accomplished. WP/RC7/3 Page 87 The WHO team of a medical officer and a serologi st was joined by a nurse/administrative officer to help the national team consisting of a medical officer, director (part-time) and 6 Samoan medical practitioners and 6 Samoan staff nurses to organize this yaws control pro ject. After training the national field staff and the labaratar.y technicians, field work in the pilot project area was commenced in September 1955. By November 1955; the survey of the pilot project area was completed. A total number of 5298 people (95% of the population) were examined clinically. A total of 1102 cases of active yaws were diagnosed and treated, together with 2704 serologically diagnosed latent cases. Fifty percent (50%) of the latent cases were not injected with penicillin. The mass treatment campaign, in which the total population was injected with penicillin, was commenced in November 1955, in the island of Savii, but had to be abandoned in December because of an outbreak of poliomyelitis which resulted in the occurrence of paralysis in peniCillin-treated patients, mostly under three years of age. On 3 January 1956, after some abatement of the poliomyelitis, total mass treat- ment was started again but this time on the island of Upclu. As of April 1956, a total of 64 702 people had been examined and treated in the mass campaign and it is anticipated that the residue of the estimated population of about 100 000 people will soon be dealt with. Full use was made of the radio and meetings with the people at all levels to win their co-operation for the project, but the outbreak of poliomyelitis, which was accompanied by the occurrence of paralysis caused much fear among the people of receiving injections, especially as a similar outbreak of poliomyelitis ocourred during a yaws campaign in 1932-1933. These fears have been largely calmed down. • WP/RC?/3 Page 88 Western Samoa 2 R WPRO 19 TA Refresher Course, Assistant Medical Practitioners (1 June 1956 - ) Aim of the project. A refresher course in preventive medicine and village hygiene for Samoan medical practitioners. Assistance provided by WHO in period under review. Three consultants" two for three months each and one for two months i ten fellowships have been awarded for the first course and a further ten fellowships is expected to be awarded for the second course; $500 worth of supplies and equipment has also been pro- vided. Probable duration of assistance. Three months. Work accomplished. The first course commenced on 1 June attended by five fellovlS from 1.~:..-stern Samoa, and one fellow from each of the following territories: Cook Islands, Fiji" Gilbert and Ellice Islands, Nauru and Tonga. Unfortunately, during the course, the senior consultant became seriously ill and an additional consul tant had to be sent to deal with the emergency. The course is organized on a group discussion, demonstration, field work basis. The report on the first course is awaited. Health Statistics Training Course, Saigon for Cambodia, Laos and Viet Nam (3-28 April 1956) Aim of the project. To permit the exchange of views on problems and services in vital and health statistics; to provide suitable training for officials in Cambodia,.Laos and Viet Nam at present employed in national, regional health and other governmoot office s and. hospitals. WPRO 21 TA WP!RC7!3 Page 89 Assistance provided by WHO in period under review. The Director Consultant of the Division of Health Statistics, WHO Headquarters, conducted this seminar; fellowships were awarded to: Cambodia - 3, Laos - 1, and Viet Nam - 3 (participants living outside Saigon (11 from Saigon and its outskirts) participated but received no fellowships); also $900 worth of supplies. Work accomplished. The training course achieved the objective of providing basic and elementary statistical training of a practical nature adapted to the previous knowledge and experience of the trainees and to the problems and needs in, and available facilities for, vital and health statistics. All trainees were in full attendance during the entire course and field trips. The seminar and the consultant's visits received consi- derable attention from different branches of the govern- ment and professional groups, stimulating the interest in the application of statistical methods in various health and related fields. The Government of Viet Nam has requested a vital and health statistics consultant and a fellowship in 1957 to assist in the re-organization and strengthening of its Central Statistics Bureau. Nursing Education Seminar, Suva (4-28 July 1955) Aim of the project. To provide opportunity through study of problems and exchange of ideas and experience for developing plans for improvement of nursing and nursing services in the countries of the Regioni to increase the knowledge and skills necessary for implementation of such plans, particularly skills in human relationships; to lay foundations and for continuing mutual assistance and inter-country co-operation. Assistance provided by WHO in pe;riod under review. Participants from: Australia - 3, Brunei - 1, Cambodia - 2, China (Taiwan) - 1, Fiji - 10, WP/RC?/3 Page 90 Guam - 1, Hong Kong - 1, Japan - 2, Korea - 2, Federation of Malaya - 2, Netherlands New Guinea - 1, New Zealand - 3, Philippines - 2, Sarawak - 1, Singapore -2'0 Papua and New Guinea - 1, Tonga - 1, Trust Territory of the Pacific Islands - 1, Viet Nam - 2, Western Samoa - 1. In addition, one participant from Australia and one from Singapore attended at government expense. Consultants: 1 ICA nurse from Viet Nam, 4 consultants and ? WHO nur sing staff member s. Work accomplish~. The seminar participants were divided into six groups for study of specific problem areas. General sessions were also he Id daily. The main topics considered were public-health nursing in the basic curriculum; the role of nursES as educators; the preparation of the "community nurse"; clinical instruction; and post- graduate education. A report is in preparation am wide distribution was urged by participants. Regional Office has been informed of follow-up activities in the countries represented. °In some of these, work-shop studies have been organized. Outstanding features of the seminar were the enthusiasm, industry and co-operative spirit in the participant group. At the conclusion of four weeks' work, there was a general expression of appreciation for benefits gained and a foeling of confidence in having learned new ways of approaching problems. Some of the initial difficulties which derived from differences in education and experience proved finally to be assets as they led to earnest attempts to reach common urrler- standing and hence a broadening of knowledge and a greater flexibility of attitudes •. The true value of the seminar has only become evident since reports have been received from participants after return to their home countries.. The experience gained has not only assisted the individuals in their own work but has also made its impact on many nurses who did not attend. In at least four countries work- shops have been succossfully conducted under the leadership of seminar participants and the value of problem solving through group work has become more widely appreciated. WPRO 24 TA WP/RC7/3 Page 91 In a questionnaire completed six months after the seminar, participants acknowledged gains of four main types: (a) International understanding - Participants commented on their personal development in this respect. Soma have been helped to a better understanding of how to plan fellowship study. Several also made reports to interested community organizations such as the Pan- Pacific Women's Association. (b) Greater skill and interest in group work. - Several participants mention improvement in their skills in conducting staff meetings and in working with com- muni ty gr oups • (c) Greater skill and confidenc$ in planning curricula at post-graduate, basic, professional and auxiliary levels. Cd) A new approach to teaching - Participants report improvement in their work through a better under- standing of principles and the use of visual aids. Others mention more emphasis on clinical instruction and better co-operation with ward personnel. The seminar provided opportunities for WHO staff members to become acquainted, to discuss common problems and to profit from one another's experience. Dental Health (Feb. 1956 - May 1956: Phase I) Aim of the project. To follow-up work of the Dental Health Seminar held in Wellington, New Zealand in 1954, and to assist the countries of the Region vThich were represented at the seminar by discussing its results and advising govern- ments on their dental-health programmes. Assistance provided by WHO in period under review. A dental-health consultant for three months to take care of the needs of the Philippines and Hong Kong from 21 February 1956 until 18 May 1956. WP/R C 7/) Page 92 Probable duration of assistance. Until 1958. Work accomplished. Mr. J. Llewelyn Saunders, until recently Head of the Division of Dental Health of the Government of New Zealand, spent two' months in tile Philippines and two weeks in Hong Kong. After these visits, he made com- prehensive reports with recommendations to the Govern ... ments concerned. These reports have been submitted to the Governments for their consideration. In the Hong Kong report, major stress was laid on the benefits to come from fluoridation of the water supply, the use of the University of Malaya for training dental officers and setting-up of a training school for dental nurses in Hong Kong. In the Philippine report, which had the additional importance that his recommendations are made in support of a reqte st to UNICEF for equipment for 260 rural dental health units. In his report, Mr. Saunders paid tribute to the planning and foresight which led to a good start towards providing a public neal th dental service but he urged the setting up of a pilot demonstration area to show the benefits to be derived from a preventive programme instead of a purely curative one. Ho stressed the med for public-health education, a survey of the total manpower needs, adequate in- servic e and 'pre-servic e training, the training of more dental helpers, provision of adequate and appropriate equipment, the appointment of more supervisors, the provision of adequate transport and simple hygienic clinics. Fluoridation of large water supply systems was recommended. He also recommended fellowships for training key dental officers in preventive dentistry. He approved lists'of equipment for the basis of a request to UNICEF. WPRO 27 TA WPRO 36 IQ WP/RC7/3 Page 93 Water Standards stuqy Group, Manila (l~27 April 1956) Aim of the project. study group composed of bacteriologists, chemists and engineers qualified in the field of water treatment and water analysis, to consider, the problem of water standards in the Western Pacific Region. Assistance provided by WHO in period under review. A short-tem consultant and participants from the Western Pacific Region: Australia - 1, China (Taiwan) - 1, Japan - 2, New Zealand - 2, Philippines - 2, Singapore - 1; and the South-East Asia Region: India - 1, Indonesia - 1, Thailand - 1. Work accomplished. The short-term consultant far t his project visited a number of Western Pacific countries prior to the Water Standards Study Group and met with local discussion groups as well as lecturing on various subj ects such as water quality am water pollution. The Water Standards Study Group was attended by 13 experts and included both technical discussions within the group of experts and open forums to which interested indi- viduals were invited. The Group successfully completed its mission which was to produce a report on proposed international standards for water quality and stamard methods for examination of water, and has submitted the report to the Head- quarters of WHO for consideration by an international group me eting there in June 1956. Psychiatric Nursi Singapore, Federation of Aim of the project. To provide consultant services "io governments whigh have requested WHO assistance in developing training programmes in the psychiatric or mental-health aspects of nursing. WP/RC7/3 Page 94 Inter-regional 20 R (FAO) Assistance provided by WHO in period under review. (financed by HQ) A psychiatric nursing consultant for three to four months. Work accomplished. Preliminary plans for the consultant visits were made during the Nursing Adviser1s visits to the four countries and planning rns continued by correspondence. Too con- sultant'has studied available material on the countries visited. Her itinerary provides for a field visit of 2 weeks to Singapore, 3 weeks in the Federation of Malaya, 3 weeks to China and 2 weeks in the Philippines. It is planned that the consultant should obtain general information about nursing education and nursing services in the countries visited and be available to advise wherever her services are needed, as well as in relation to the specific programmes for which WHO personnel will be recruited, viz. training of assistant mental nurses, Federation of Malaya; training of psychiatric nurses, Singapore; mental-health aspects of basic nursing education, China. The Organization will also welcome too advice of the post-graduate public-health nursing course in Penang and also of the course which will open in 1957 at tte Urban Health Centre in Singapore. In the Philippine s, where no programme of assistance in psychiatric nursing has yet been requested by the Government, plans haVxe been made for the consultant to advise on prOVision of adequate nursing care to patients with acute mental illness; provision of nursing services for the less acutely ill (patients with psycho-neuroses and psychosomatic illness); and training of nurses and otiBr personnel responsible for direct patient care in mental h~spitals or in psychiatric wards of general hos- pitals or in community services. FAa/WHO Nutrition Education and Health Education Seminar, Baguio (13 Oct. - 3 Nov. 1955) Aim of the pro je ct. To improve the basic understanding of health education and nutri tion education in the Region; to stimulate the exchange of ideas about health-education methods and techniques. WP/BJ)?/3 Page 95 Assistance provided by WHO in period urrler review. Participants from the Western Pacific Region: Australia - 3, China(Taiwan) - 2, Federation of Malaya - 3, Hong Kong - 2, Japan - 4, Korea - 2, Macau - 1, Netherlands New Guinea - 2, New Hebrides - 1, New Zealand - 1, Singapore - 2, Territory of Papua and New Guinea - 1, Timor - 1, Viet Nam - 3, Western Samoa - 1, Philippines - 9, Hawaii - 1, and the South- East Asia Region: Burma - 3, Ceylon - 1, India - 3, Indonesia - 5, Thailand - 5, attended the seminar. Consultants from the following organizations and universities were present: FAO - 4, ICA - 1, WHO - 6, USPHS - 1, University of Sydney, Australia - 1, University of Canberra, Aus tralia - 1, Rural Health Demonstration and Training Centre, Philippines - I, One observer each from UNICEF, United Nations and UNESCO attended. Work accomplished. By means of small group discussions, plenary sessions, field trips, library study and the like, the participants and participating staff worked together on selected com- ponents of health education in terms of concepts and methodology. Besides an attempt to correlate their findings the participants also devised plans for imple- ITB nting the ideas gained at the seminar in their back-home situations. A comprehensive report of the seminar has been prepared by the Seminar Director to serve not only as a guide to participants in their work but also to furnish general information about the seminar findings and the procedures used. LIST OF REGIONAL OFFICE POSTS ORGANIZATIONAL UNIT POST OFFICE OF REGIONAL DIRECTOR I - Regional Director I - Administrative Assistant L - Secretary Public Information I - Public Information Officer L - Information Clerk L - Secretary BUREAU OF HEALTH SERVICES I - Medical Director I - Statistician L - Socretaries (2) L - Clerk/Statistician L - Clerk/Typist Advisory Services I - Regional Public Health Administrators (3) I - Regional Adviser on Health Education of the Public I - Regional Malaria Adviser I - Regional Tuberculosis Adviser WP/RC7/3 ANNEX I NATIONALITY China U.K. P.I. U.S.A. F.I. P.I. P.I. VACANT P.I. VACANT VACANT (1) China (2) U.K. (3) VACANT I - Regional Venereal Diseases Adviser I - Regional Maternal and Child Canada P.I. U.K. U.K. Fellowships Secretarial Pool for Advisory Services OFFICE OF ADMINISTRATION AND FINANCE I - Internationally recruited L - Locally recruited Health Advjser I - Regional Environmental Sanitation Adviser I - Regional Nursing Adviser I - Regional Adviser on Education and Training L - Fellowships Assistant L - Secretary L - Clerk/Typist L - Secretary L - Clerk/Stenographers (6) U.K. u.S. New Zealand VACANT P.I. P.I. P.I. P.I. P.I. I - Administration and Finance Officer Norway L - Secretary U.S.A. WP/RC?/3 Annex I page 2 Budget, Finance and Accounts Personnel General Services AREA. REPRESENTATIVES (aigon Cambodia, Laos, Viet Nam) Singapore (Brunei, Federation of Mal aya, North Borne 0, Sarawak, Singapore) ~ TSOUth Pacific Area) I - Budget & Finance Officer I - Finance Officer I - Chief Accountant L - Accountant L - Assistant Accountant L - Accounts Clerk (2) L - Budget Clerk L - Cashier L - Clerk/Stenographer I - Personnel Officer L - Personnel Records Assistant I - Administrative Service Officer I - Translator (English/French) I - Assistant Translator (E/F) L - Translator (English/Chinese) L - Procurement Clerk L - Supply Clerk L - Travel Clerk L - Registrar L - Registry Clerk L - Mail Clerks (2) L - Librarian L - Clerk/Typists (4) I - Medical Officer L - Clerk/Stenographer I - Medical Officer I - Medical Officer L - Clerk/Stenographer U.K. U.K. China P.I. P.I. (1) P.I. (2) VACANT P.I. China P.I. U.K. China Netrerlands Switzerland Switzerlam China P .1. F.I .. P.I. P.I. P.I. (1) China (2) VACANT P.I. P.I. U.K. Viet Nam China Canada VACANl' WP/RC7/3 ANNEX II CONSULTANTS EMPLOYED DURING THE YEAR PROJECT FIELD NUMBER NATIONALITY - CHINA 20 Mental Health 1 Canada HONG KONG 4 Maternal and Child Health 1 U,K, JAPAN 10 Medical Social Service 1 U .S,A, JAPAN 11 Environmental Sanitation 1 U.S,A. PHILIPPINES 12 Parasitology 1 U.S.A. Epidemiology 1 U.S.A. Nursing / 2 U.S.A. v Biostatistics 1 U,S,A. PHILIPPINES 47 Medical Education 1 U,S.A. SINGAPORE 2 Almoner Training 1 U.K. SINGAPORE 4 Nursing v 1 U.K. WESTERN SAMOA 2 Preventive Medicine 1 New Zealand. Sanitary Inspection 1 New Zealand WPRO 10 Trachoma 1 U.K. WPRO 21 Adult Education 1 U.S.A. Education Psychology 1 Australia Social Anthropology 1 Australia WPRO 24 Dental Health 1 New Zealand WPRO 27 Public-Health Engineering 1 U.S.A. WPRO 36 Psychiatric Nursing v 1 South Africa INTER-REGIONAL 20 Seminar Director 1 Australia Health Education 1 P,I. Social Anthropology 2 Australia WP/RC7/3 ANNEX III PROJECT AND REGIONAL OFFICE INTERNATIONAL STAFF EMPLOYED AS OF 30 JUNE 1956 Country Regional Office Area Field Total - Australia 3 3 Austria 1 1 Belgium 1 1 Bolivia 1 1 Canada 1 1 6 8 China 3 1 4 Denmark 1 1 France ... 5 5 Germany :2 :2 Greece 1 1 India 1 1 Israel 1 1 Netberlan::l.s 1 3 4 New Zealand 1 5 6 - Norway 1 1 Philippines :2 3 5 Switzerland :2 :2 United Kingdom 8 :2 11 21 United States :2 7 9 21 3 53* 77 .><. A Consultants not included. WP/RC7/3 ANNEX IV GEOGRAPHICAL DISTRIIDTION OF INTERNATIONAL STAFF TERMINATED OR TRANSFERRED Country Regional Office Field Consultants Total Australia 1 5 6 Austria Belgium 2 2 Bolivia " Canada 3 1 4 China 1 1 2 Denmark 1 1 France 2 2 Germany ... .. Greece India Israel .. Netherlands 1 1 New Zealand 1 1 2 Norway 1 1 Philippines 1 1 2 Switzerland ,.. United Kingdom 4 2 6 United States 5 7 12 2 22 17 4~ WP/RC7/3 ANNEX V LIST OF SUPPLEMENTARY AGREEMENTS SIGNED WITH MEMBER COUNTRIES DURING THE PERIOD 1 JULY 1955 TO 30 JUNE 1956 COUNTRY TITLE OF PROJECT WHO NUMBER BRITISH SOLOMON ISLANDS Yaws, leprosy, BCG British Solomon Islands PROTECTORATE Protectorate 1* CAMBODIA Maternal and Child Health Cambodia 4* Demonstration (addendum to planops regarding supplies and equipment furnished by UNICEF) CAMBODIA Royal School of Medicine Cambodia 5 CHINA Venereal-Disease Control China 1* (Addendum 3) CHINA Environmental Sanitation China 14 CHINA Tuberculosis Control China 17 CHINA Mental Health Chirla 20 FEDERATION OF MALAYA Nutrition Federation of Malaya 12 FEDERATION OF MALAYA Hospital Administration Federation of Malaya 14 FEDERATION OF l.fA.LAYA Hospital Records Officer Federation of Malaya 15 FIJI Yaws control (Addendum 1) Fiji 1* FIJI Central Medical School Fiji 2 (Addendum 1) JAPAN Environmental Sanitation Japan II JAPAN Nursing Education Japan 14 KOREA Midwifery Training ** Korea 9 (Addendum 1) PHILIPPINES Public-Health Administration Philippines 32 PHILIPPINES Medical Education Philippines 47 SINGAPORE Urban Health Centre Singapore 4 SINGAPORE Hospital Records Singapore 9 *Joint with UNICEF **UNICEF/KCAC programme: WHO technical approval r OFFICIAL TRAVEL DURING THE PERIOD 1 JULY 1955 - 30 JUNE 1956 NUMBER OOUNTRY VISITED S~¢:i~n MEMBER OF PURPOSE OF VISIT PA VTSTT v _S 'I'S American Sam:>a lUth. Ed. 1 To study health-education activities with a representative of Adviser the South Pacific Commission •. Australia PHA 1 To plan the 1957-1958 programmes for Australia and the terri- tories; to investigate training facilities in universities and research institutes. PIO 1 To discuss with the Director of the United Nations Information Centre for Australia and New Zealand the problems connected with the di stribution of WID material in Australia and New Zealand and to make oontacts with th e representatives of the press and radio in Sydney. Cambodia PHA 2 To conduct the new WHO school-health officer to Phnom-Penh; to discuss area representativeship with the Government; to discuss medical education with the Royal School of Medicine; to discuss co-ordination with UNESCO, FAO and US-ICA missions in Cambodia; to review progress on WHO-assis ted nursing, maternal and child heal th, BCG and malaria proj eets. Mal. Adviser 1 To confer with the WHO malaria project staff in Cambodia; to discuss with government officials concerning the co-ordination of malaria-control activities. MCH Adviser 1 To review the WHO/UNICEF-as sis ted maternal and child health proj ect and to di scuss its development wi th the Goverrrnent and WID staff; to become acquainted wi th local conditions and pro- i blems. I ! I I I TOTAL NUMBER OF WORKING DAYS SPENT n THE OOUNTRY 6 14-1/2 3 8 4 7 I I t ~ ~ >< <l H ~ :e:: ~ f5 ~ \..» COUNTRY VISITED I STAFF MEM BER PAYlOO VISIT Camodia China (Taiwan) Nurs. Adviser TB Adviser VDT Adviser Pers. Officer PIO RD Env. San. Adviser Mal. Adviser NUMBER OF VISITS 1 1 2 1 1 2 2 1 ---r TOTAL NUMsEIf"· 'g g ~ OF WORKINJ ~ m ;;- DAYS SPENT. IN I\) >< .8 THE COUNI'RY ~ ~ PURPOSE OF VISIT To visit nursing and midwifery education project" di scu ss pro- blems and revise plan of operations; to visit the maternal and child health project end discuss plans and personnel for future nursing assistance. To visit the BCG campaign; discussions on international role in tuberculosis-control projects. To discuss venereal-disease and treponematoses problems with the Government; to review the yaws problem in Cambodia and dis- cuss the proposed control programme. To discuss with WID staff regarding personnel rratters and related problems. To arrange for the WHO exhibit at the International Exposition which was later held there, and to collect material on the BCG campaign, the maternal and child health, and nursing projects. To confer with government authorities on WHO-assisted projects and 1957-195S progra~s. First visit: For discussions and detailed planning with offi- cials of Government in oonnection wi th the environmental sani- tation project. 7 2 4 6 4 10 7 Second visit: To accompaqy the newly-appointed WHO public- 7 health engineer, and assist him in assuming his position there. To confer with the Director of the Taiwan Provincial Malaria Research Institute and other government officials concerned regarding (1) the use of DDT-BHC mixture in the 1956 spr~ing operations, (2) government and ICA assistance to the project in FY 1957, (3) WID project supplies am equipment for 1956, and (4) the services of a malaria advisory team in 1956. 4 -------..,..-------r------r-----------------------------r---- ---_.( . 'IDTAL NUMBER OOUNTRY VISITED I STAFF MEMBER PAYIID VISIT China (Taiwan) Federation of Malaya MCH Adviser Nurs. Adviser TB Adviser VDT Adviser PHA Env. San. Adviser NUMBER OF VISITS 1 3 2 2 1 1 PURPOSE OF VI SIT To visit the WHO/UNICEF-assisted maternal and child health pro- ject; to discuss with til e Government and WHO staff the pro gress made; to review plans for future development of the maternal and child healt h programme with the Government. First visit: To visit an d dis cuss programnes of the nursing and maternal and child heal th projects; to become_ acquainted with government, university and WHO personnel and receive orientation k' health and nursing services and schools of nursing and mid- wifery. Second visit: To discuss plans and problems of nursing project wi th university personnel; to meet the team leader o.!> the mater- nal ani child health proj sct. Third visit: To confer with university personnel and make plans fer future WID assistance in establishment of a collegiate school of nursing; to vi sit the maternal ani child health project and discuss midwifery training. To review the tuberculosis-control programme including the mass BCG campaign; to install the WHO medical officer; to carry out preliminary planning for a leprosy-control project. First visi t: To install the WHO medical officer and hold dis- cussions wit h go verrnnsnt officials and co-ordina ting agencies. OF WORKING DAYS SPENT IN THE OOUNTRY 6 16 9' 5 Second visit: To observe the venereal-disease control project 16 and hold di scussions with government officials and project per- sonnel. To visit the nursing, midwifery and rural-health training pro- jects; to plan 1957-1958 programmes. To visit the Federation of Malaya at the request of the Director of Medical Services. 8-1/2 1 '0 g; Sl> • ~ ~ CD CD ~ :>< c w.q':: H\ NUMBER OOUNTRY VISITED I SfAFF MEMBER OF PAllID VISIT VISITS Federation of Hlth. Ed. 1 Malaya Adviser Nurs. Adviser I 2 TB Adviser 2 VDT Adviser 1 1M Officer 1 PIO 1 I I ~'O!l>~ PURPOSE OF VI sn To carry out heal th-education consultations for the It/OO-assisted rural-health training cenke,.Jitra. First visit: To become acquainted with government ani WHO per- sonnel and nursing and mldwifezy programmes in the Federation; to visit the nursing-education project and rural-health training centre; to di. scuss existing programmes and the governrne nt request for furtre r assis tance. Second visit: To visit and discuss the above projEcts, discuss revisEd plan of operations, plan for orientation of new staff members. First visit: To discuss WHO assis tance in the field of tuber- culosis cxmtrol. Second visit: To develop the leprosy-control project and to discuss tuberculosis activities. To observe field 'WO rk of the yaws control project in Kelantan and Trengganu; to meEt the new medical officer in-charge of the project and to di scuss future operation of the project "Wi. th the responsible authorities. To conduct the two nurse educators to their assignments in the Federation; to introduce the new are representative; to discuss administrati ve problems with WHO staff; to assist on proje ct reqUEsts am their costing with the Director of Medical Services and his staff. To do a phow story on the WHO nurse educators giVing courses at the NurSing School, Penang, and of the Rural-Health Training Centre, Jitra. 10F WOReING cfci 9 ~ DAYS SPENT IN : ~ § THE COUN'lRY ;:i ~ )-1/2 11 5 :3 11 9 4 6 COUNI'RY VISIT EDI STAFF MEMBER PAUID VISIT Fiji Hong Kong PHA ID.th. Ed. Adviser PIO RD Mal. Advis er MCH Adviser Nurs. Advis er TB Adviser NUMBER OF VISITS 1 1 1 2 2 1 2 1 PURPOSE OF VISIT To visit the Central Medical School project; to plan the 1957- 1958 programmes for Fiji and the South Pacific Health Service; to di scus s projects with the South Pacific Commission secre- tariat, ani to vis it tb= Filariasis Research Unit. To study health-education activities "With a representative of the South Pacific Commission. To do a number of stories on the yaws Programme and the Central Medical School. To co nfer wi th gJveI'11I1l2nt authori ties on 1957-1958 pro gramme requests. To assist the Medical Department of Hong Kong in assessing the malaria problem in the Colony and in drafting plans for an intensive antimalaria campai gn. To visit and review the WHO/UNICEF-assisted maternal ani child health project with the Goverrnnent and WHO staff before their dep:! rture, and to become acquainted with the main na ternal and child health problems am services in the Colorv. I TOTAL NUMBER OF mRKING DAYS SPENT IN THE OOUN'lRY 11-1/2 6 4 4 17 8 Fjr st visit: To become acquaint ed with WHO per sonnel , visit thE printer re nursing manuals for t he China 6 project. 1 Second visi t: To visit the ITa ternal and child healt h project aId assess nursing accomplishments; to visit the schools of nursing and midwifery and discuss nursing fellowships. To follow up the EGG campaign; to discuss tuberculosis control with government authorities. i 5 3 '"CI ~ :0 ~S~ (1) (1) ~ \.1l><~ <: ........ Hu COUNI'RY VI SITED Indonesia Japan Korea TOTAL NUMBER NUMBER OF WORKING STAFF M:EMBER OF PURroSE OF VISIT DAY S SPENT IN PA NG VI SIT V SITS THE COUNTRY Mal. Advi ser RD DRS Env. San. Adviser Nurs. Adviser PIO RD MCH Advis er 1 1 1 1 1 1 1 1 To discuss (1) meams of oo-ordinating malaria-control prograrrmes in the areas bordering Sarawak and North Borneo, (2) malaria activities in Portuguese and Indonesian Timor, and (3) relevant points of the expanded and accelerated malaria-control programme in Indonesia. To confEr with governmEnt authorities on 1957-1958 prograrrme and to survey thE leprosy-control services of the Government. To discuss the 1957-1958 programme. To meet in Tokyo, Professor F.W. Gilcreas, Consultant on the Water Standards Stuqy Group held in Manila, 15-27 April 1956; to vis it the composting project in Kobe. To receive an introduction to nursing and midwifEry schools and ServiceS in Japan; to visit and discuss the WHO-assisted nursing education project. To contact the Jara neSE Governmm t in connection with t.h€ dis- trib uti on of WHO ITa ter ial, ths story on the Crippled Children t s Hospital and t h2 -work of the WHO Nurse Educator. To confer with government authori ties on future WID assis tance. To review the governIrlEflt prograrrme of refresrer training courses far ~ivate practising midwives assisted by UNICEF am AKF. To study the ITajor health problems affecting mothers and children, th; s ervic es availabl e to th em, ani to discuss pos sibl e future developmen ts wi th tre Govenuoon t. 4 5 4 12 9 2 2 10 I ~ :g~ <D <D ::0 ~~ H \..V COUNTRY VISITED I STAFF MEMBER PAYIID VISIT NUMBER OF VISITS PURPOSE OF VISI T TOTAL NUMBER OF WORKING DAYS SPENT Hi THE COUNTRY ------------~--------~------r_--------------------------------------------_T1 ----- Laos PHA Mal. Advis er VDT Adviser Macau I Mal. Adviser Netherlands New I ~~l. Adviser Guinea New Caledonia New Hebrides TB Advis er ID..th. Ed. Adviser ID..th. Ed. Advis er 1 1 2 1 1 1 1 1 To dis cuss 1957-1958 WID assistance with the Government; to dis- cuss co-operation wi th US-ICA,; to discuss malaria control with the Government, Thai ani US-rCA workers. To diseuss the reqUEst of Laos fur assistaroe in malaria co ntrol; to co nfer with government of ficials concerning the co-ordination of mala ria-control activit ie s. First vis it: To install the WID medical officer in Laos and discuss ven: real-disease ani treponematoSEs problems with the Government. Second visi t: To observe the operation of the yaws control project in Laos and dlscuss the- progress made and future plans for the project wi th the Government, co-ordinating agenciE s and the WID medical officer. To discuss with the Government the malaria problem in Macau and to SEe how WHO might be of assistance. Tb review the ant1malaria programme, estimate future requirements and i'urthE r assis tance needed by the programne. To initiate the BCG c§l.mpaign. To study health-education activities with a representative of the South Pacific Commission. To study heal th-education activities wi. th a representative of the South Pacific Commission. 4 2 1 4 4 6 9' 6 5 "C1 ~~ ~ !j~ m m ~ -..J><~ ;:j~ ill UNrRY VIS I TED New Zealan:i North Borneo Philippines STAFF MEMBER PAYING VISI T PHA Env. San. Adviser Mal. Advis er PHA Env. San. Adviser lllth. Ed. Adviser Nurs. Advis er TB Adviser NUMBER OF VISITS 1 1 3 4 1 1 2 4 PURPOSE OF VISIT To plan tre 1957-1958 pro granmes for New Zealand and the island terri tories; to vi sit WHO fellows, the Postgraduate Nursing School ani the Universi1qr of Otago. To review the pro gress on the environmental sanitation project and discuss with the Government the Establishment of a rural environmental sanitation project. To install the new malaria team at their duty station; to review the progress of the rralaria project, discuss development and expansion of th e progranme, detennine additional supplies and equipmen t required in 1956-1957. One visit to the leprosy-control project (4 days) and three visits to the schistosomiasis project, Leyte (9 days). To visit the schistosomiasis control pro ject for the purpOSE: of reviewing the public-health engineering aspects of the project To co-ordina te arrangerents for t he field visit of participants in FAO/Wm Nutrition Education and Health Education Seminar. First visit: To observe factii ties ani discuss plans for opening of the Cebu midwifery school; to visit the Regional Training Centre in Cebu. Second visit: To visit hospitals, scmols of nursing and mid- wifery and training centres in Manila; to observe midwifery and maternal and child health programmes and discuss midwifery pre- ject with the Governmen t. To inspect the mass BeG campaign; to plan BOG consolidation; to evaluate the leprosy-control pilot project in Cebu and Iloilo. TOTAL NUMBER OF vlORKING DAYS SPENT IN THE: COUNrRY 8-1/2 9 4 13 4 3-1/2 ) ) ) )- 20 ) ) ) 14 "t:1 i:;" ~ ~ S.!:!=!. m CT> ::P xn 00 ....,J t:l~ . COUNTRY VISITEDI STAFF MIMBER PATING VISI T Philippines PIO Sarawak I Env. San. Adviser Singa:pJre I PHA Env. San. Adviser Nurs. Advis er TB Adviser ME' Officer PIO Tahiti ill th. Ed. AdviEer NUMBER OF VISITS 1 1 1 1 2 2 1 1 1 PURroSE OF VISIT To take photographs to illustrate a story on the wolk that is being carried out in Cew am Iloilo by the leprosy-control team.i To visit Sarawak in response to a government request for assistance in planning an environmEntal sanitation programme. To visit the University of Mala.Ya; to plan the 1957-1958 pro- grammes. To visit Singapore in connection wi th WPRO seminar. To visit the nursing-education project, disCll ss programme and plans; to discuss problems of nursing-education project, plan for WID assistance in psychiatric nursing, discus s recormnenda- tions of expert ronunittee in public-healt h nursing. First visit: To follow up the BCG campaign and discuss with gcvpr"'1ment authc;rlties, Second vi si t: To carry out preliminary discussions on the Pan- Malayan Tuberculosi s Conference. To assist the Director of Medical Services with thE costing of and details of project requests for 1957-1958; and ocnferences with staff on operational and administrative problems. To take photogr-aphs on the woIk of the "100 nurses in the General Hospital. To study health-education activities with a representative of the South Pacific Commission. TOTAL NUMBER OF WORKING DAYS SPENT IN THE OOUNTRY 2 4 2-1/2 5 5) )-11 6) ) 5 9 2 1 14 .. -----;~-- '0 ~ ~ II) §~ (J'Q Cl) In ~ ~ >< (') ....J ~~ I COUNTRY VISITED Thailand (Bangkok) Tonga Viet Nam STAFF MEMBER PAYIm VISIT VDT Adviser PHA PHA Mal. Adviser MCH Adviser Nurs. Adviser TB Ad .... ser Pers. Officer PlO NUMBER OF VISITS 1 1 3 1 1 1 1 1 1 PURPOSE OF VIS IT To consult with UNICEF ARO and UNICEF TAM in Bangkok with regard to UNICEF-assisted venereal-disease and treponematoses programmes To plan the 1957-1958 programmes, especially the rural environ- mental sanitation project. To gather infer nation on effects on \-IHO staff of impending insti- tution of separate currencies; to review progress of maternal am child health and BCG projects; to discuss draft agreement on tuberculosis project with the Government; to review preparations for the Statist ics Training Course; to consider the new school for health technicians project; to confer with TAB and US-ICA officials. To confer with officials in Viet Nam concerning the co-ordination of malaria-control activities. To review the WHO/UNICEF-assisted maternal and child health pro- ject with the Government ani WID staff; to discuss plans for future dewelopment in Saigon and in the provinces. To visit the maternal and child health project and discuss plans for future developments in nursing aspect. To visit the mass BCG campaign; discussions on international role in tuberculosis-control projects. To discuss with WHO staff regarding personnel !Tatters and related problems. To do a photo story on the WID participation in the Children r s Hospital. 'TOTAL NUMBER OF WORKING DAYS SPENT IN THE COUNTRY 4 1 9 3 4-1/2 3 3 6 6 ) '"0 ~. ~ ~ g, :~~ o ;:t~ NUMBER COUNTRY VISITED STAFF MEMBER OF P AYlOO VISIT VISITS Western SanPa Hlth. Fd. 1 1 Adviser I i CONFERE~ES Africa VDT Adviser 1 AIlstralia TB. Adviser 1 Cambodia Mal. Adviser 1 Ceylon Env. San. 1 Adviser Federa ti. on of PllA 1 MaJ.~ Mal. Adviser 1 Fiji PHA 1 ~s. Adviser 1 PIO 1 Greece . Mal. Advis er 1 i , PURroSE CF VISIT To stuqy health-education activi. ties with a representative of· I the South Pacific Commission. ! , To attend the Second International Yaws Conference in Nigeria. T~ s10teUQ 1:4e As1an-Pacifio Tuberculosis Conference .. To attend the Phnom-Penh Malaria Conference. To act as consultant of the SEARO Enviroll.1OOntaJ. Sanitation Seminar in C~lon. To attend the Filariasis Study Group. To attend the Filariasis Study Group. To attend the South Pacifi c Commission Conference. To attend the WHO Rtrsing Education Seminar. To rover the WID Nursing Education Seminar. To attend the Malaria Conference for Eastern Mediterranean ani European Regioris, and the sixth session of the Expert Committee on Malaria. - ------------ 'IDTAL NUMBER I OF WORKING I DAYS SPENI' IN, THE ro UNTRY ! --I 12 I 3? 9 10 20 10 10 3 32 18 20 I , i i "U>:( ~ S~ (D~~ ~:ca~ H\A NUMBER 00 UNTRY VIS ITED STAFF MEMBER OF' , PATING VI SrT VISITS India Env. San. 1 (New Delhi) Adviser Japan DHS 1 Philippines Hlth. Ed. 2 Adviser Nurs. Advis er 2 Sarawak Mal.. Adns er I .1 i i p.~ PURPOSE OF VISIT To attend preliminar,y meeting on Rural Health Conference. To attend the Far East Conference on Worle fur the Blind. Fir st vis it: To attend the FAO/WHO Nutrition Education and Health Education Seminar,. Baguio. Second visi t: To act as oonsultant at the AnnUal Meeting of the Philippine League of Provincial and City Health Officers, Baguio. To attend the FAO/WHO Nutrition Education and Health Education Seminar, Baguio. To attend the First Borneo Inter-territorial Malaria Conference. - TOTAL NUMBER-' OF "WURKING DAYS SPENT IN THE COUN'ffiY 6 11 22 1 2-1/2 5 I __ I 't:J :x> ~ ~ S~ CD ~ 25 I-' -...J l\.><l .......... H \.0 FELLOWSHIP AWARDS 1 July 1955 to 1) June 1956 According to Fields of Study and Countries of Origin Health Organization and Services PUBLIC-HEALTH-ADMINISTRATION Public-health administration DPH, MPH Hespi tal and medical care administration Standards in and management of mental hospitals SANITATION Environmental sanitation DPH, MPH Environmental sanitation Sanitary engineering Food control Bacteriological food testing ~ . ~ p: ~@ ~ ~ ; ~ ~~ c3 Ed < 0 :2 1 1 ~ ~ CI) ;:S ~ CI) ~ ~ ~ CI) ~ ;:S H ~I 8 I:;l ~ ~ ~ g3 ~ H ~ @ ~ ;:S 0 r:. ~ 1 :2 1 1 1 1 1 ~ ~ il CI) ;:S ~ ~ I I ~ ~ ~ ~ c9 ~ ~ ~ bj 6 E-I 1 1 ~ i ~ ~ ~ ~ I> I ! ~ .. -, i ~ ~ ~ f5 ~ U> '. NURSING Nursing and midwifery Nursing education Nursing organizations' administration and nursing education Medical nursing Obstetrical nursing Paediatric nursing Surgical nursing Midwifery Medical social work Almoner (tuberculosis services) MATERNAL AND CHILD HEALTH Organization of maternal and child health services Child health Care of premature infants Diploma course in public health Maternal and child health - ~ ~ rg ~ 1 1 - ~ g3 ~ ~ CI} CI} H ~~ ;:i CI} E-t I H m ~ ~~ ~ H !:d 8 ~ H &1~ ~ ~ (.) (.) 1 1 1 1 1 ~ ~ ~ ~ ~ Iii ~ :::> II ~ :z; e ~ ~ 8 ~ ~ ~ ~ ~ ;:S 1 1 I~ i til ~ ~ ~ I~ ~ ~ ~ lit P-. H t3 ~ t..::t i~ ~ ~ :z; ~ H CI} E-t :> 1 2 1 1 1 . L-- "- ~---- 't:f ~:E; III ::s '"0 O'Q ::s "- (1) (1) ~ l\)><.s < .......... HW H " OTHER HEALTH SERVICES Mental health Care of mentallY retarded children Child psychiatry Child psycholo gy Mental health Psychiatric nursing Psychiatric social work Psychological medicine Health education Diploma course in public health Health education and leprosy control Health education and venereal diseases Nutrition Diploma course in public health Health statistics Epidemiological statistics Hospital statistics Medical statistics and epidemiology Vital and health statistics *short group training course **second year award ~ ~ ~ i:i ~~ ~ ~b ~ <I! tI) @ I ;:S tI) § 1-1 <I! i ~ ::..:: ~ ~ 8 ~ ~ 1-1 ~ @ c.:> c.:> ~. 2 lR [ft 1 1 1 ~. J. ~ tI) I ~ ~ il i~ 1-1 R: :<::i ! ~ ~ ~ ~ ~ ~~ ~ ~ ~ 1 1 1 1 1 1 1 1* ~ ~ ~i ~~ ~ ~ i~ t1 es E-I 1 1 1 1 ~ ~ I ~ ~ > 3* 't:.I :x:-~ I»S"; ~ CT>~ >< n \/.)<~ I-I\/.) H • Dental health Diploma course in public health Drug control Drug control Communicable Diseases Services OOMMUNICABLE DISEASES A ND LABORATORY Malaria Malaria control Mosquito cyto-genetics Venereal diseases and treponematoses Diploma course in public health Venereal diseases Yaws control Tuberculosis Ambulatory chelOOtherapy 0 f tuberculcsi.s BOG vaccine preparation and apPlicatDn Diploma course in public health Thoracic surger,y ~ C7l ~ ~~ ~ ~~ < (J) ~ (J) ~ ~ (J) H ~ ~ (J) ~ ~ H ~ :z; ~ ~ :>0:: H ~ ff !i:! 8 ...., H ~ @ ~ u u f;L. :>0:: 2 1 1 2 1 1 1 2 1 1 1 ~ ~ (J) fi ~ ~ ~ ~ Iii t! '1 fiJ p., ::> !j ~ S ~ ~ I ~ ~ ~ H (J) 1 2 1 1 ~; I~ ~ ~ !~ E-t ~ 2 1 1 ~ U1 z ~ ~ , . "CJ:t>-:E; ~ §~ (1)(0:;0 X 0 ~ ~s. H • Tuberculosis, chronic diseases, geriatrics, rehabilitation Tuberculosis control Other communicable diseases Diploma course in public health (epidemiology) Leprosy control Quarantine and port sanitation Laboratory Laboratory methods in neo-natal and infant pathology and cytological diagnosis of bronchogenic carcinoma Medical zoology and entomology Parasitology Medical Education, Clinical and Basic Medical Sciences CLINICAL MEDICINE Surgery and medicine Undergraduate medical studies Anaesthesiology z ~ S ~ U} ~ ~~ t:i ~ § ~ 3 i~ ~ 1 ]0+ ~ ~ ~ H d ~ H ~ ::.:= ~ z ~ ::.:= H fS 0 if Ii! 8 ~ 5 H H ;;. 0 0 I%.t 0 ::z:: :.:::: 1 1 2 1 1 1 1 1 + Subsistence support given national undergraduate candidates studying at the Royal School of Medicine, Phnom-Penh • ~ ~~ ~ U} r,£ ~ ~ ~ ~ ~ ~ ~§ ~ fj§ fa ~ H ~~ fi1 tt i~ ~ ~ ~ N H ~ c5 U} f.H H E-I 0 ~ ~ 5:! ~~ ~ f=l U} ~ ~ ~§ H ~ Il.. U} E-I > 1 1 1 1 >0 ;.> =-:: ~ S~ CD ~ e: Vlj:j~ H .-~ ·' BASIC MEDICAL SCIENCES AND EDUCATION Basic medical sciences Chest physiology and histology Pnysiology and biochemistry Medical education Assistant medical practitioners refresher course Schools and training centres for health technicians Total- * short group training course ~ ~ ~ .::x: 3 ~ ~ ...:I 0 rJ) ~~ ~ S 0 9g ~ ~ c3 1* 1 14 . rJ} CI) ~ ~ rJ) ~ H d z CI) E-! 0 H ~ ~ ~ z ~ ~ d ~ 5:! 0 z 0 H H g ~ (.) (.) rx. d 1 1* 1* 1* 25 1 5 1 6 11 ~ ~ ~ ~ H ~ I; 85 ~ f:@ ~ ~ N 8 ~ ~ ~ ~ ~ 1* 1* 9 1 1 1 1 1 -~~ ~!- ~, CI) fl@ ~~ (3' ~ :a: H ~~ P-. ~ l§. (l., (l., ~ ~ § r:iI ~~ &4 ~ ~ f:1 H ~ rJ) E-f :> 1 1* 1* W 1 14 6 3 2 8 10 Grand total - 124 9:t>-~ ~ 5~ <D<D:=tJ >< (') ~~ H PLANNING ~I ...... -.. --............................ -~ PROPOSALS FRCJ1 GOVERNMENTS FOR INDIVIDUAL OR PROJECT F ELLOtl SHIPS --- ...• -.~.- f. PLANNING I NoD I V I D U A L FELLOWSHIPS - .- ---- .......... ,---~ YEA R APPROVING YEAR OPERATING YEAR .- ,"4"' - .-. ~ >+ • >t ~ g MIOOR ~ « I~ ~ .......... --.......... _ . .. -.. --) ~ .................. . .. __ ... _ ...... _ .... _ ........ -.... __ ......... ADJUSTMENTS HEADQUARTERS NOTIFY OF REGIONS OF STUDY PLANS • WHO I 0' • .. -_ ...... -_ ....... .... AI I'-.. ~ ttl PROCEEDS TO PLACE 0 FELLGlS I GOVERNMENTS E-I SUBMIT :;a:; AS SOON AS POSSIBLE 0 APPLICATIO NS H AND I E-I « INFORM 0 REGION OF ORIGIN H H ~ WHO I « E-I PROCEEDS TO ARRANGE ~ AWARDS AND TRAVEL i ~ ~ ~ r:z:1 0 H ttl r:.:.. E-I ~ H ~ H ~ S ~ ~ ~ :.;;: .~ t:il ~ ~ (,) H ~ H d ~ t>-I I:Q ~ H E-I i s CI) ~ 0 * * * -.-.....- i ;:1 ~ J ~ ~ ~ ~ \..)
WORLD HEALTH ORGANIZATION REGIONAL COMMI1TEE Seventh Session Manila 7-13 September 1956 SIXTH ANNUAL REPORT OF THE REGIONAL DIRECTOR TO THE REGIONAL OFFICE FOR THE WESTERN PACIFIC wp/RC1/3 Corr.l 14 August 1956 ENGLISH ONLY REGIONAL COMMITTEE FOR THE WESTERN PACIFIC Corrigendum Page 7, 3.5, first paragraph, line 9: Please delete "6011 and substitute "61". ANNEX III, second column against China: Please insert "1". fourth column against China: Please delete "4" and substitute "5". second column against United Kingdom: Please delete "2" and substitute Ill". fourth column against United Kingdom: Please delete "21" and substitute "20".