Fifth annual report of the Regional Director to the Regional Committee for the Western Pacific

WORLD HEALTH ORGANIZATION REGIONAL COMUTT EE Sixth Session Singapore 13-19 September 1955 Agenda item 10 FIFTH ANl'U AL REPORT OF THE REGIONAL DIRECTOR TO THE REGIONAL OFFICE FOR THE WESTERN PACIFIC WP/Rc6/3 18 July 1955 ORIGINAL: ENGLISH REGIONAL COMMITTEE FOR THE WESTERN PACIFIC J .. 1 2 3 4 5 6 7 'CoNt~~TS PARTT GENERAL INI'RODUCTION •••••••••••••••••••••••••••••••• .. THE FIFTH REGIONAL COMMITTEE •••••••••••••••• , •• 11" ••••••••••••••••••••• THE RIDIONAL OFFICE AGREEMENT S· \fIlTH GOVERNMENTS ................. COLLABORATION WTIH OTHER AGENCIES ••••••••••• NATIONaL FUBLIC HE8.LTH CO-ORDINATION C 0l'1l11 Tr E.ES • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • RJBLIC INFORMhTION •••••••••••••••••••••••••• PART II - GENERAL STATEMENT OF ACTIVITIES IN THE RIDlON 1 RJBLIC HEHLTH SERVICES 1.1 1.2 1.4 1.5 1.6 hssistance to governments in the development and strengthening of their henlthservices Maternal and child health ••••••••••••••••• N\lI'sing ••••••••••••••••••••••••••••••••••• Ehvirorunenta1 sanitation •••••••••••••••••• Heal th education of the public e· ••••••••••• . ,Mental health ••••••••••••••••••••••••••••• 2 COMMUNlCilBLE ·DISErt.SE CONTROL 2.1 ·Malaria con~rol .. ~ .......•••.• ~ .....•...•• Tuberculosis and BCG ....................... . Venereal diseases and treponematoses ••••••• Pa.ge 1 1 .3 .6 6 1 9 12 13 15 .16 .16 17 18 19 19 3 ENDEMo-EPIDEMIC DISEhSES 3.1 Filariasis and other insect-borne virus diseases ••••••••••••••••••••••••••• Filariasis ••••••••••••••••••••••••••• Arthropod-borne virus diseases· ••••••• Poliomyelitis •••••••••••••••••••••••••••• 4 EDUCk.TION .€iliD.TRiUlIJING . ,', ~"ssistance. to educational inst:itutions .. , Fellowships .. ' ''''' ~ ~ ••••••• ~ ••••••••••••••• Educa tional. meetings ••••••.••••••••••••••• Pk.RT III - ACTIVITIF1? BY COUNTRIES ...... , ....... 1 AUSTRlJ.IA 1.1 Health Education ......................... Education and Training ................... 2 BRUNEr 2.1 Nutrition ..... ~ ......................... . 2.2 Malaria ·Control. •••• •••••••• I,e •••••••••••• 3 .. CAMBOmA 3.1 Public-ijegltn Administration - . . ~ " ~.. " .. ,... ••••••••••••• .•... },1a ter~al.l¥ldChild . Health •••• ~ ~~ ....... .. 3.3 ........................ ... ", .~a+~ria Cont~9+ .•• ~~ •••••••••••••••••••••• BeG •••••••. ' ....... : • ~ ... ' ••••••••••.•••••••••• e, , ................... . ....... 41 , • ,. • •• • ••••• ,,!10 •• t' Page 20 20 21 21 22 22 23 24 24 24 24 2.5 2.5 2.5 26 26 26 4 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.B 5 5.1 CHINk. IvIaternal and Child Health " •••••••••••••••••• Nursing Education •••••••••••••••••••••••••• Env'ironme"irt:,"al Sa nit a tion ••••••••••••••••••• Malaria Eradication •••••••••••••••••••••••• B-CO ." ••• e' .~.' • • e' ...................... ' • •••••••• Venereal-disease Control .................... Trachoma Control ••••••••••••••••••••••••••• Triple Vaccination" " ••••••••••••••••••••••••• FEDERATION OF 'MALAYA'" " , Rural-Health Training Centre ...... ' ........ . " Nurs ing Edu cation •••••••••••••••••••••••••• Mental Health .............................. ., Yaws Control , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . FIJI' , 6.1 6.2 7 7.1 7.2 B B.1 8.2 8.3 8~4 Yaws Control ............................... . Education ani Training ..................••• HONGKONG , Ma terna.1 and Child Health •••••••••••••••••• Health Education .........................•. haternal and Child Health .................. Nursing Education •••••••••••••••••••••••••• Environmental S&nitation ••••••••••••••••••• 'Education and Trainitg .••••••••••••••••••••• Page 27 27, 28 28 2.8 29 29 30 30 31 -32 33 '34 34 34 35 35 35 9 KCRFA ..... ~ Gene ral ••••••••••••.••.•••••••••••••••••••• 10 ".U9$ 1.0.1 .. " f .. 11.1 11.2 l1idwif<:iry Tr~ining ••••••••••••••••••••••••• Education and Train.ing ••• ..J , .'., Tr~pon~ma~~~s.Co~tro~, Edu cati~::m ~nd Training • •••••••••••••••••••• • •••••••••••••••••••• • •••••••••••••••••••• M~?ria OO!ltrol •••••••••••. ' •••..••..••••••• Yaws Control •••••••••••••••••••••••.••••••• 12 N.~ ,Z.EAU.ND 12.1 13.1. 13.2 13.3 14.1 14.4 14.7. , 14.8 ~. p. ~ ~ 14.9 1l!ducation and Training ••••••••••••••••••••• Nursing Educati~n •••••••••••••••••••••••••• Environmental Sanitation ••••••••••••••••••• .,M~laria Pilot Projec~ .•••••••••••••••••••••• Public-Health ~dministration ••••••••••••••• ~mterna1 and Child Health .................. ~udwi~~y~:a~~ng ••••••••••••••••••••••••• Environmental Sanitation ••••••••••••••••••• SChistosom,iasis Control Pilot Project •••••• BCG . ~ .. ~ ................................... . Tre:pon~a t?ses Cem trol ••••••••••••••••••••• Le~ros?" ~?~~:ol •••• ,f ••••••••••••• o' ••••••••• Education and Training • •••••••••••••••••••• Page 36 36 36 36 37 37 37 38 38 38 39 39 39 40 40 40 42 15 SilRAWAK Environmental Sanitation .................. Malaria Pilot Project ••••••••••••••••••••• 16 SINGb.PORE 16.1 16.2 Urban Health Centre ••••••••••••••••••••••• Nursing Education ••••••••••••••••••••••••• Education and Training •••••••••••••••••••• 17 TERRITffiY OF PJJ>Ui~ i.IID NEW GUINEA. 17.1 18.1 18.2 18.3 i'Ialaria Control ••••••••••••••••••••••••••• Public-Health administration .............. Maternal and Child Health ................. BCG ....................................... 19 INTER-COUNTItY ffiOGRAMMES 19.1 19.2 19.3 19.4 BCG i.ssessment Team ...•................... Dental Health Seminar ................•.••• Smallpox Survey •.......•.••.••••••.•.••••• Nursing Education Seminar ••••••••••••••••• 19.5 Nutri tion Education and Health 19.6 1 2 3 Education Seminar ......................... Statistics Training Course •••••••••••••••• ANNEXES List of Regional Office Posts Consultants Employed during the Year Geographical Distribution of Project and Regional Office International Staff Page 44 44 L4 4S 45 46 46 46 47 47 47 48 48 48 49 4 5 List of Supplementary Agreements signed \d th Member Countries during the Period 1 July 1954 . ." ,~. ....... . to 30 June 1955 , ~. ,~.. Fel10\-Tship Awards 000 ., . ,,' ",'t .",,, .. 1 INTRODUCTION we/Rc6/) Page 1 Expansion, both in breadth and in depth, of the activities of the Regional Office for the Western Pacific has been the chief ~harac~eristic 6f the period from 1 July 1954 to )0 June 1955' which is cove,red by this report. As in previous years some projects were terrrllnated, others initiated, while a few were redefined in the light of experienoe gained and signi ficant changes in looal situations which have developed since their initiation. The scheduled termination of projects has imposed on the office the responsibility of seeing thl t these are continued under national counterparts, as planned, and an advisory service on this aspect of the work is constantly being given by tte regional techni cal staff. The preliminary phases of some projects have been completed dW'ing the period under review and these have paved ,the way for the start of new ones patterned along the findings made. The introduction ,of and/or emphasis on certain activities which the Regional Committee, tre World Health Ass embly or the Executive Board have particularly directed this offie e to unde::-take 'has been effected 'whenever .feasible. In t he schistosomiasis project there has been a more compre- hensiv~ approach to the epidemiology of the disease so as to include the socio-economic and other related aspects of the problem and tre use of this project to spearhead community development in the area , has been a significant development during the period. Quite a nwnber of negotiations in connection with the implementation of country aIIi inter-country actiyi ties have reached the fiml stage. Greater emphasis has been given to activities benefitting more than one country' and inter-country projects have been encouraged as far as practicable. 'i'he increaSing interest shown in mental health arrl denta.l health has resulted in the planning of progr_es in these fields. It is expected that the introduction of tne§e activities will result in expanded programmes in the two fields. The'BCG projects, which have been in operation in certain countries for some time, have now been as sessed by an expert team and pre liminary steps toward their integration into the general public-health actiVities of these countries have alrea~y been taken. A similar plan for integration of the yaws projects is also under consideration. The closest co-operation has been obtained from governments in connection with the planning, implementation, development or redefinition of projects. While recruitment of personnel particularly for the French-speaking countries anl: for some specialties has not • been without some ,d,ifficulties, this has, by and large, been solved ina satisfactory manner. 2 THE FIFTH RIDIONAL COMNITTEE The fifth session of the Regional Committee was held in Manila from 10 to 16 September and was attended by representatives /of all •••• WP/Rc6/3 Page 2 of all Member States in the Region. The Governments of France, the Netherlands, Portugal, the United Kingdom of Grea~ Britain and Northern Ireland, aDd the United states of America, responsible for territories .. in the Region, were represented by local health administrators. . ('." Representatives from the United Nations Children's Fund (UNICEF), the United Nations' Technical Assistance Board (UNTAB), the United Nations Korean Reconstruction Agencr.y (UNKRA), the International Labour Organization (ILO), the WHO Epidemiological Intelligence Station in Singapore, and observers from other agencies and of sixteen non- governmental organizations in official relations with WHO were also present. The Director-General was represented by an Assistant Director- General. The Regional Committee endorsed certain modifications in the proposed programme and budget for 1955 which were made necessary by the reduction in the budget decided upon by the Seventh World Health Assembly, and adopted a resolution proposing that, if .funds became available from budgetary savings in 1954 and 1955, priority should be given to health projects requested by Cambodia, Lao.s and Viet Nam as contained in tre supplementary list of projects. In examining the proposals for 1956, the RegiohalCommittee stressed the importance of organizing regional conferences, lectures and study tours, which, it was believed, would foster cordial relations and understanding among Member States in the Region, and requested that every effort should be made to allocate funds for this purpose. Consideration was also given to establishing criteria for the selection of projects to be financed from r~gular funds, and the Regional Directcr was asked to prepare such criteria for the consideration of the Regional Committee at its sixth session. The importance and control of insect-borne virus diseases in. the Western Pacific were discussed. The Regional Committee recommended that experts in the Region should be asked to prepare papers on the public-health aspects of this prCblem for consideration by members of the Expert Advisory Panel on Virus Diseases, and wi tha view to the holding of a seminar. The Regional Committee approved the report of the Regional Director, expressed appreciation of the growth in the regional fellowship programme and recommended the re-establishment of the post of statis- tician am prog ramme evaluator (cancelled during the year) so tha. t governments might benefit from this fom of assistance • . ' " . ... The subject of the technical discussions was public-health administration: with particular reference to the organization of health departments, and discussion was focused on (a) methods of obtaining suitable workers for health departmEnts; (b) the basic health unit in areas with limited or no health services; and (c) the use of mlllti- lateral.and bilateral assistance for h~alth programmes. The Regional Committee considered the djgcussions useful but felt tmt a more limi"led subject should be chosen for. the technical discussions at the sixth session.· . . /The Regional •••• wp/Rc6/3· Page 3 The Regional Committee decided to hold the sixth session in SingaPore in 1955, and ihe seventh session in Manila, unless the Regional D~rectorreceived an invitation before the sixth session to hold it elsewhere. 3 REGIONAL OFFICE 3.1 General On 1 September 1955 the Regi~nal Office will have been four years in Manila. Relationships with and co-operation from the Host Government have co ntinued to be excellent. The office has now reached a stage of maturity which pennits complex situations to be dealt with more easily and operational activities to proceed more smoothly. 3.2 Accommodation As mentioned in last year's report there have been certain problems in regard to a.ccommodation. The most urgent repairs and maintenance have been attended to by the Government, but as permanent accommodation the present buildings are inadequate. At the end of June 1955 the Government, as a first step in complying with the request of the Organization, decided to donate land for a permanent WHO building am the responsibility for consulting with the Organization' on the prac~ical details of how to proceed was delegated to the . . Secretary of Health. Further developments are expected within the next few months. 3.3 Organizational structure ' The organi zational pattern approved in 1952 has been adhered to except ,in the following two cases (a) it has not yet been possible to fill the post of statistician and progranme evaluator owing to budgetary limitations; and (b) two positions subject to local recruit- ment were established in 1954. One of these local posts was for a secretar,y in the Fellowship Unit in order to deal with the greatly expanded fellowship programme and seminar arrangements. The other was for an assistant translator in the French language, although it.has, as yet, not been possible to find a suitable candidate locally. , 3.4 Regional office staff Several changes have taken place during the period under review among the . international staff: The Regional hdvis er on Education and Tra'ining was transferred to .the vacant post of Public Health Administrator on 1 July 1954, and the former post was filled in November 1954. Two staff members who have been with the office since its establishment, the Regional Nursing Adviser and Public Infonnation /Officer •••• WP/RP6/3\ . Page'4 \. Officer have been transferred, the. former to the Nursing Section at Headquarters am the latter to the WHO Liaison Office in New York. The post of Public Information Officer was filled on 1 August 1954 and that of tl13 Nursing Adviser on 1 May 1955 •. The post of Interpreter changed hands with the transfer of th e former holder to the Regional Office for Europe; his replacement arrived in May 1955. The post of AdmiI)istrative Assistant was filled in August 1954. The Regional Adviser on Tuberculosis, who has been absent for eleven months on home and study leave" during which time he has taken tre MPH degree at Harvard University, returned to the office in June 1955. The turnover among locally recruited clerical staff bas continued to be insignificant; between 1 January 1952 and 30 June 1955, there. have in fact been only seven terminations. This has undoubtedly been highly beneficial in that a permanent staff will, as time goes on" obtain a thorough knowledge of the Organization, its aims and procedu~s and will thus be able to cover additional and more complex duties and tl13reby absorb a great part of the steadily increasing workload. The advantages arising from having a trained team ~ve, however" brought about certain budgetary complications. On the one hand the Regional Office has carried and will,fcr some time to come, carry nearly the maximum burden of statutory increases, and on the other, the great majority of local staff will, in 1956 am 1957, be entitled to the maxinun annual leave 00 days). ' Actually in 1957 a computation of present roster shows that the absence on annual leave alone will exceed four working years for one staff ~ember" to which mve to be added other absences due to sickness, etc. In Annex 1 will be found a list of the regional office posts" including geographical distribution. 3.5 Project staff The position of staff assigned to projects is of necessity rathe~ different. The turnover will always be high Owing to the termination of projects" the completion o~contracts, staff reaching the age-limit or being transferred to other regions. The project staff as at 1 July 1954 totalled 52 persons" including one consultant" employed on 23 different projects. ThecomparaDiv6 figures at 30 June 1955 are 62 staff members" including .6' consultants, employed on 33 different projects; . In the year 19 project staff, excluding consultants, have been terminat~, while 24" also excluding consultants, were recruited. This high turnover with resulting recruitment, travel" briefing and termina- tion arrangements haS created a great deal of work for technical and administrative staff. Annex 2 lists the ,.conSultants emploYed during the year, while Annex 3 shows the n'lUl'ber of project and international regional office staff employed at,JO June 1955" bo~h with geographical distribution. /It is felt ••• .. :,,' '\ wp/Rc6/3 Page 5 It is felt tho. t one of the project staff should be particularly mentioned, Dr. E. Demos, who was the first team leader of the malaria project in Taiwan, and to whom a great deal of credit should be given for the successful work performed by that project. He fell seriously ill in October, had to be moved to the Uni te d states and after a long am painful illness, died in May 1955. 3.6 Increased activitjes During the year field actiVities have been enlarged to include projects in the South Pacific. Th€ magnitude of the increased workload mentioned above may be indicated by the following compar-ison on one item only, tmt is the number of incoming alIi outgoing letters which have passed through registry: Incoming: Outgoing I 1952: May 479 620 1953: May 517 667 1954: May 729 693 1955: May 1241 1229 3.7 Technical Assistance Programmes Another factor 'VoThich has contributed towards a higher workloaa ani has also created additional problems has been the developments in regard to Technical Assistance funds. The tentative allocation for 1954 amounted to approxi~Ately $550 000, of which only $440 000 were firmly allocated fer priority I projects. From August onwards the ceiling was rais ed by stages up to $63~ 000. This nade it pos sible to implement several proj ects and in particular fellowships which had been either given a lower priority under TeChnical Assistance. for 1954, or appeared in the Supplementary List. It was also possible to advance some of the fellowships originally planned for implementation under the Regular budget in 1955 in view of the fact that some of the TA money represented a refund of money which had to be diverted from the Regular budget to continue Technical Assistance projects during the crisis early in 1954, This creat~d a chain reaction which necessitated continued revisions of the pr~ramme and budget and at this moment work is still proceeding on the advancement to 1955 of fellowships am other activities which had been originally imluded in the programme for 1956 or appeared in the Supplementary List. ~n malring these revisions the pertinent resolutions of the fifth session of the Regional Committee were kept in mind and special attention has been paid to Cambodia, Laos, Viet Nam, and Korea. In some way or other fourteen of t he countries and territories within the Region and some inter-country programmes have benefi tt'ed from tOOse revisions" In spite of these problems it is gratifying to' be able to report that it proved possible to use with advantage before too end of 1954 more than 99% of the total amount of funds from all sources which was made available to our field activities. lother ••.• wp/Rc6/3 Page 6 ) Other administrative problems which have had tq be kept continuously in' mind. mve been the influence of war and disturbed conditions in some Member Countries and the need to make every effort to utllize non-convertibl~ currencies to the greatest possible extent. On the last point, and particularly with regard to the payment of qir fares- in local currencies, close co-operation has been received from Member Oountrios. 4 AGREEMENTS WITH GOVERNMENTS A basic agreement for the provision of technical advisory assistance was concluded between tte Organization and the Government of the Republic of China. Negot iations are in progress with the Govermnent of Japan in regard to the conclusion of a basic agreement under the Expanded Programme of Technical Assistance for Eco~omic Development. '" The Regional Director is acting on behalf of all the specialized agencies represented on tre Technical assistance Board. Twenty-one supplementary agreements (plans of operations) were signed during the period under review. A list is given in Annex 4 to this report. . 5 COLLABORATION~v.rrH OTHiR AGENCIES 5.1 With other United Nations Agencies During the period under review, a considerable number of acti. vities of the Western Pacific Regional Office have been undertaken or accomplished in collaboration with several agencies of the United Nations. / i~s in the past technical approval ani guidance have be~n given to a large number of projec1:,s for mich UNICEF is the chief sponsoring agency, and close liaison has been maintained with the UNICEF Asia Regional Office. A sizeable number of projects are being financed under 1he Techniml Assls tance programme and meetings have been held both with tre Liaison Officer of the Technical Assistance Board in tre Philippines and with-the new Regional Representative of the Board, who visited Manila for discussions on current and proposed projects. The Regional Office has also co-operated with the United Nations Techni<ml Assistance Mlministration (UNTM) in connection with .its South and South East Asia Conference on Community Organization and Development held in Manila during the latter part of November and early part of December :1;954. The Organization is al 00 assisting in the UNTAA project in the Philippines for which the schistosomiasis project in Leyte is being used as an approach to community development. This programne is also being used as a pilot project for other provinces in the Philippines. Assistance has been given in the planning of the UNESCO Bayambang Community School Project in the Philippines and a nutrition education and /heal th education •• / wp/Rc6/3 Page 7 health edumtion saninar to be held in Baguio , Philippines during the latter part of the year is being planned in co-operation with FAO. In agreement wi.. th the Regional Office for South-East i1.s.ia, observers haV€ been sent to seminars organized by tre Econanic CanmiB- sion for As"la ani t he Far East (FCiJi'E) whenever items on the agenda were of interest ani whenever it was feasible to do so. 5.2 ~'1itIt.. bilateral agencies The Regional Office has continued to fulfil its responsibilities as la:id down in the Constitution for co-ordination of international health activiti~s. The Regional Office was represented by the Regional Director and two staff members at a joint WHO/FOA meeting in Delhi" India from 22 to 26 February 1955. This conference was called in order to disquss common objectives and problems of FOA and WHO in areas covered by the Eastern Mediterranean, South-East l1.sia, and Western Paoific .Regional Offices of the Organization. One of the major themes discussed: was tlrel'!_tionship with other agencies" and i.JHO 1 S role as co-ordinator of regional h~alth activities was recognized and discussed at that time • . The function of public-health co-ordination cQmmittees in those oountries which are being assisted by international and bilateral agencies was di scussed and th e value of tre se committees in increasing the efficiency of external aid to individual countries was stressed. The importance of the appointment of area representatives was also "' emphasized,,' as this contributed towards closer liaison between the governments and tm agencies concerned. In Cambodia through agreement between ttE Govenunent, WHO ani FOA, the WHO personnel stationed in the country are serving as technical advisers to tl':e FOA Mission Chief and as FOl1. advisers to the Government pending the appointment by FOA of their om technical staff. 5~3 With non-governmental agenc :iss Too Regional Office has sent observers to the Regional Meeting of the lnt ernational Federation of University Women" which was held in Manila 16 to 23 January 1955" also to the Seventh Meeting of the Research Council ~ the South Pacific Commission held in Noumea 20 to 30 June 1955. 6 NATIONAL PUBLIC-HEtU.TH PROGRAMME CO-ORDI~TION COMMITTEES 6.1 China The Co-ordination Committee on Foreign Aid in Medicine and Health in Taiwan, China" formed early in 1951, is comp~ed of representatives of the National Health Administration, the Provincial (Taiwan) Health i~dministration" tre Chinese Red Cross, the Joint Commission on Rural Reconstruction" the National Taiwan University /Medical School •••• wp/ff£6/J, . Page' 8·· Medical. School, the National Defense Medical Centre, WHO, the United Stat~s Foreign Operations administration (FOA), the American Bureau for Medical idd to China and the United States Military j"ssistance Advisory GrO;Up., The Committee meets every Saturday morning. m new aspects of health 'WOrk, whether assisted by ou tside agencies or not, are reported and 'di scussed with a view' to obtaining the fullest co-operation ani co-ordination ~d the avoidance of overlapping and reduplication of effort. Foreign health workers on official visits to Taiwan are usually invited to attend meetings of the Committee. Several subcommittees have also been created to study and advise on specialized subjects. The Committee also acts as the selection cOmmittee for candidates f Q[',WHOfellow ships. ' . . Philippines An outstanding example of a rethod utilized for successful co- ordination of interm tional health wrk is tre Public Health Programme Co-ordination Committee in'the Philippines. This Corruni ttee, initiated at the suggestion of WHO in December 1951, msnow been in existence fOF four years. During this period thirty .. six regular' and special meetings Mve been held with representa- tion. by the philippine Department of Health, the Philippine National Economic Council, UNICEF,. WHO, the United States Foreign Operations Mission to the Philippines (FOA), the Resident Technical Assistance Representative in the Philippi.t:l6s and the Philippine Social Welfare . administration. The latter two agencies were added to tre Conuni ttee durin~. t!le year under review. The ten subconunititees which deal with specialized .areas in the field of public health have been active in co-ordinating country prcgramme s and reviewing long-range plans of the Government. A new subcommittee to deal 'Wi. th the training of health personnel was activated during the current year. In some instances, joint meetings of subcom- mittees were arranged for deliberations on overlapping programmes. Staff members Of the· Institute of Hygiene of the University of the Philippines are now represented on each of "!:be ~bcommittees for the purpose of creating a clo~er relationship between teaching institutions and operating governmental and assisting agencies in matters of public health • . A study group was set up by the Conunittee for tl'E. pUl'pose of studying:the; pX'·ocedure far the cons iderationo f fellowships byFOA and the Uni t.ed Nations agemies. A brochure entitled "Co-operation for a Healthy Philippines" was printed and dis tributed to. rural health units and health officers; this was compiled by the three assisting agencies - t\lHO, UNICEF and FOA ... and the Department of Health and describes the progress of the. health work being done in the Philippines. . ... /PUBLIC INFffiMATION 7 PUBLIC INFORMATION 7.1 General wp/Rc6/3 Page 9 The Public Information Office of the Western Pacific Region has two main objectives - one is to tell t~ story of the World Health Organization in general, and of the work in the Western Pacific Region in particular, to the peoples of the countries in t~ Region; the other is to gather for the Division of Public Information at Head- quarters, and tm Depar1:.n¥'3nt 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 the world of the work of WHO. , To carry out these objectives with maximum results in spite of limited funds, the Public Infonnation Office during this period again undertook to enlist the assistance of governments in the . Region both in the dissemination and in the production of infonnation material. M earnest effort was also made to get lmO personnel in the various WHO-assisted health projects to produce material which . could be used for public information purposes. The response of the governments has been very encouraging and in most countries liaison officers have been given the responsibility far pranoting and co-ordinating public information activit:ies with the WPOO Public Infonnation Office. How valuable such appointments are was amply demonstrated by the excellent co-operation of these officers in connection with the successful observance of World Health Day in most of the countries of the Region this year. Sane rna te;rial has been Ie cei ved from the WHO field staff, and it is hoped tha t more IllS. terial will be received from the field in tee . com:i,.ng ye ar • During the year the Public Information Off:ice continued to expand its work through the use of all available media including press, radio, films, visual displays and direct mailing of inforne tiop material. 1.2 Press During the year 105 press releases, press notes and special features were issued, am a total of 21 000 copies of them were sent to approx:imately 200 outlets in the Region. The high cost of postage, is a limiting factor in increasing the mailing list for press -material. This is made up, however, by efforts to induce the public infonnation agencies of governments to help distribute such material within 'their respective countries. Thus, in Japan, the Chief of the Inibrmation and Liaison Office of the Secretariat of the Ministry 0 f Health ani Welfare has made arrangements for HIrO press material to be translated into Japanese and distributE'd, with the result ttB.t tre Japanese press makes extensive use of WHO material. an effort is being,made to get other countries to follow the Japanese example. /7.3 Films and •••• WP/Rc6/3. . Page 10 . 7.3 Films and filmstrips The limited number of films on the work of WHO continued to be circulated throughout the Region thrcugh WHO field personml, United Nations associations and other groups. Efforts to·. interest some agencies ~o pr.oduce short documentaries on the work of ~VHO in the Region have qeen started. _ It is felt, however, that some financial support from WHO Will be needed before a satisfactory film on the work of the Region wlll ~e produ oed. b. limited number of copies of the filmstrip on the organization iln d fum tiona of WHO which was prepared by the Division of Public lnformation at Headquarters was distributed to same goveDnments far review and comments. The reaction so far received has been favourable. 1.4 Radio The repaired off'i ce tape recorder and t he co-operation of the R,adio Seot:Lon of tre United States Infonna tion Services in Manila have made it possible to increase the radio material gathered fram the Region. For instance, the recordings made during the Second bosian Malaria Gonference in Baguio in December 1954 and during the visit of the Public InfarPlation Officer to tIE :Jchistosomiasis control pilot project in Palo, L,eyte" ?hilippines, were used by the Radio· Division of the Uni -red Nations in their nl1emo from the United i'Jations l1 ~eries, aprogramtne which is qr.oadcastand re-broadcast by hundreds of radio stationsthrou~t tiE r!orld, Recordings dealing with the work of WHO and also of the United Nations which were reoeived from the Department of Public Information of the United Nations in New York continued to be broadcast regularly over one of the leading radio stations in Manila. Arranganents were also made for re-broadcasting these programmes over local provincial stations in the Pbilippines. 7, $ Photographs During the period, over 900 photographs dealing with the various activities of WHO in the Region were taken. A selection of these photo- graphs were enlarged at Headquarters for distribution to a wide number o.f publications .10 the form of photo stories •. 7·.6 . Exhibits .. .. During this period, the Office received from Hea.dquarters· five sets: of the WHO travelling exhibit...These sets, which are attractively desigled" light and handy, and caIleasily be: made part of larger exhibits" were us ed extena iv ely. . . The French set was sent to the WHO office in Saigon where it has been use9- as p:l.rt of tre e~bitson thewQrk of WHO organized by the Government • /The BCgliBh ... wp/Rc6/3 Page 11 The Fllglish set was displayed in Manila in connection with the observance of World Health Day in July 1954 and, again" in September 1954, during the fifth session of the Regional Committee. It was also displayed in Singapore where it formed part of the United Nations Exhibit held there in October 1954, after whic~ it was used in Kuala Lumpur, Federation of Malaya, during the National Conference on Adult Education held there in December 1954. Another set was sent to Suva, Fiji, to be displayed during the Second Nursing Seminar which will be held there in July 1955. Two exhibits, one consisting of six panels and the other of five panels, were prepared bythe'Office from enlargements received from Gereva. .One dealt in a general way with the work· of WHO in the Region and this was displayed in Manila and in Singapore~ The otmr one. dealt wi. th the. schistosomiasis control pilot project in Palo, Leyte, and was shoWn in Manila. This will also be shown in. a munber of provinces in the Philippines. 7.7 Publications A pamphlet for the Western Pacific Regional Office was printed and will soon. be distributed in the Region. This twelve-page illustrated· publication sUIlllllarizes the work whiCh the ~egional Office has been doing in the vlestern Pacific Region since it was .established in 1950. It is intended to bring this pamphlet up to date every year. 7.8 World Heal,th Day As in previolls years, this event was again successfullY ooserved in the Region. In this connection, the Public Information Office distributed .2800 World Health Day information folders, in English, French am Chinese, containing World Health Day messages and articles, a round-up of the activities of WHO in the Western Paoific" Region and the WHO folder, to all heads of health administratiortsin the Region, tre Uni ted l~ations associations, the United Nations' Volunteer e~cation centres, the United Nations Speaker Units, and medical schools. In addition to information folders, over 100 photo- graphs illllstrating the \'lorld Health Day theme "Clean water means Better .Health" were also sent to newspapers and other periodi.~ls. Tape recordi.ngs of the World Health Day messages of the DiIector- General and. ~m RegionaJ. Director were sent to a number of radio stations. Although they were received in Mariila too late for distribution on World Health Day, 3000 World Health Day posters and photo sheets prepared by the Division of Public Information at'Head- quarters were nevertheless sent to th e countries of the Region. It is very enco~aging to note that more and more the observance of World Health Day is becoming a truly nation-wide popular affair. No longer is its celebration limited to metropolitan /centres •••• WP/Rc6/3 Page 12·'· centres of population. Rural areas, through the assistance of local governmental bodies and schools, are now participating in World Health Day celebrations. PART II - GENERAL STATEMENT OF ACTIVITIES IN THE REGION 1 PUBLIC HEALTH SERVICES 1.1 Assistanoe to governments in the development and strengthening of their heal th services . Most of the countries and teITitories in the Region were visited by the Regional Director and/or regional office staff during the·period under reView. Members of the headquarters staff and several specially recruited. shart-term consultants also visited the Region on specifio assignments. Valuable information was exchanged and advice given. During the months of February, l"1arch, April and May of 1955, the Regional Public Health Administra mrs visi. ted many of the Western Pacific oountries and territories to discuss the new TAED procedure and projects in 1956 am 1957 which would require WHO and/or UNICEF assistance. . The WHO Public-Health Administration Speoialists in Cambodia and Viet Nam are serving as country re})resentativ.es~responsible for the· co- ordination of the work of \VHO and/or UNICEF-assisted projects with that of bilateral agencies. The \VHO Public-Health Administration Specialist in Cambodia is also entrusted with the co-ordinator's role in Laos. In Ca.mbodia the Ministry of Health has been strengthened by t m addition of more technical staff, while in Viet Nam the Hinistry of Health is being re-organized with the advice of WHO and FOA public-healthsfElcialists. The Organization is assisting in the development of rural health services in Canbodia and the Federation of Malaya and in the establishment of ail urban health oentre in Singapore. Every effort is being made to use communicable-disease control pro grammes, such as yaws, as a means of developing the rural. health progranune by integration of the work into the local health services. Health services are also being strengthened by the organization of education and training programmes, the provision of assistance to teaching institutions and the award of fellowships. For example in China (Taiwan), the WHO projects are based ona programme of decentralisation so that medioal personnel in health centres and health stations through- out the island may bemfit from tre training activities of tm teams. Details of tre assistance provided under speoial subject headings will be found in the following pages. • AITangements have been oompleted for the translation of the International Sanitary Regulations into Chinese arid negotiations for a Japanese translation of the International Pharmacopoeia are making satisfactory progress. /1. 2 Maternal ••• 1.2 Maternal and Child Health General wp/Rc6/3 Page 13 In reviewing the maternal and child health work in the "lestern Pacific Region for the past year, it is of interest to note the general emphasis placed on maternity care and the importance of supervision and refresher courses for the practising midwife who ma;y be working in the community, either as 'a member of the public health service, or in private practice. In Cambodia, Hongkong, the Philippines and Viet Nam this aspect of the maternal and child health programme is being stressed. The need for.closer co-ordination between the health ,centre pre-natal and post-natal' clinic services and the d.micilialY midw.i. ves has also been stressed. To achieve a complete maternity care programme there must be good teamwork between the medical officer, public-health nurse, midwife and the nutritionist. Each member of' this team must realize the importance of the other and the contribUtion that he or she has to make. Each needs to be faniliar with the other's approach to the problem but muSt, realize that all are needed if the best possible care is to be given. 1.2.2 Child develOpme~t Another section of maternal and child health which has been receiving much attention in certain countries within the Region is mental health in childhood, the study and teaching of child developnent and child guidance clinic work. . The first countr,r to ask assistance from WHO in a mental health in childhood' programme was the Philippines. The assistance asked was in the establishment of a child guidance clinic. This was delayed pending the establishment of a mental health section in the Department of Health and also the finding of suitable candidates for fellowship stuc\Y. Much active work has been eDne by the Philippine Mental Health Association, whie{l . received high commendation f'r6m the Chief of Section in Mental Health, WHO Headquarters, during his recent visit. A sub-committee of the Philippine Public Health Co-ordination Committee on Mental Health has been formed and has devoted attention to planning a mental health in childhood programme. As a result of the work of the committees of the Mental Health Association and the Philippine Health Education Association, approval has been gr&"1ted and an allocation made by the Government towards the fonning of the Institute of Child study. A suitabJB fellowship candidate has been found by the Goverrnnentf'or a WHO stuqy progranme in psychiatry, including mental health in childhood. lIn Singapore ••• WP /RC6/:,3' .. · Page: 14." In Singapore a request for assistance in the establishment of a child guidance clinic was received two years ago but investigations revealed that it would be more important first to train a psychologist, psychiatric social worker and a ps.ychiatrist in the child development aspect of mental health before such a demonstration clinic could be established. In Hongkong also a request for assistance in forming a child guidance clinic was discussed and again it· was considered more important first to train national teaching personnel in each of the disciplines associated witp this work and to have a visit from a short-tenn consultant on mental health in childhood, to confer with members of the University and the various departments concerned. Plans are being made to implement this programme. , Orthopaedically" handicapped children The first country assisted in this fie ld was Japan who asked for assistance in the consolidation and expansion of existing services for the protection of children against crippling and deformities. Such assistance was provided in the form of two short-tem consultants and fellowships. Assistance in an orthopaedic programme was requested by Hongkong in the fom of two fellowships, for a. physio-therapist and a nurse, to study the convalescent care of orthopaedica11y handicapped children. The fellows will work in a convalescent hane which has been established through the generosity of a private benefactor. The Government has provided the land and the supervisor of the programme is the government orthopaedic specialist. . The Philippine Government has requested assistance in an orthopaedic progrannne, for 1J1ich UNICEF assistance 1s also asked. WHO has been requested to provide fellowships for study in brace appliances and boot-prosthetics but Ul~ICEF requires a much fUller investigation of the facilities providedan:l the nation-wide aspect of the ·proposal before being willing to support the request • Countries where maternal and child health has been reviewed DUring ,the year several oountries have been visited to obtain ba6kground information on maternal and child health standards and services, 'namely, the Caroline Islands in tho Am.erican Trust Territories; the Trust Territory of Ne-:v Guinea and the Territory of Papua and also Netherlands New Guinea. In these countries up to 'the present, the major health problems of malaria, yaws, tuberculosis, have· had to receive priority but now great interest is being shown in improving maternal and child care services a.nd correl.ating them with nutrition and health education programmes. /1.3 Nursing 1.3 Nursing WP/RC6/3 Page 15 Several nursing education programmes are progressing toward the developnent of teacher training facilities. Assistance has been given in strengtheiJing clinical teaching and improving nursing services. National counterparts are being prepared to take",Jincreasing responsibility for nursing leadership and teaching materials are being produced in several countries through the joint efforts of WHO and government nurses. Nation~ nursing cOIilmittees in several countries are sup'porting nursing IX' ogress and helping to co-ordinate nursing "activities. A stuQy of nursing needs, personnel and resources is under wa:y in Japan, and a similar study of public-health nursing in Singapore has been arranged as a foundation for planning educational pr~grammes. Upon the request of four Member Countries, a nur~ing. eduoation seminar has been arranged for 1955. Fifty-three nursing parti~ipants and discussion leaders fram twenty countries in the Region are meeting in Fiji in JulY. As requested by the participants at the 1952 seminar, the topics for study will centre around: (1) the relationship of hospital and nursing service administration; (2) the basic education of nU!'ses with particular efforts to clinical nursing practice; ". (3) the preparation of nursing teachers; (4) the preparati?n of auxiliary nurses and midwives. The study groups will have leadership by consultants in education, nur~ing education, soci.al anthropology and educational psychology. The discussions will be in French and English. Nursing leaders in the countries have been studying their nursing needs to identif,y problems for guidance of the seminar participants. It is anticipated that the technical discussions at the sixth session of the Regional Committee on the subject, ""Daniciliary Midwifery as an Approach to the People in the Developnent of the Rural Health Services", will stimulate governments further to assess their midwifery services. ' In preparation for the Ninth World Health AssemblY technical discussions on the topic , "Nurses - their Education and their Role in Health Programmes", documents have been distributed to Member States and to national nursing associations. Governments have been requested tOo use the help of organized nursing groups in their consideration of the questions around which discussions will be based. /1.4 Environmental WP/Rc6/3 Page '16: 1.4 Environmental Sanitation The problem of ~vironmental sanitation in the Region covers a wide spectrum. This spectrUm is dictated by many factors including the huge geographical area of the Region, wi th consequent climl:}tological, topographical, geological and cultural differences. Problems vary from those resulting from the concentration 'of large numbers of population in urban areas and the aggregation of industries, to the basic problems posed in the sani. tation of small rural communities wi th highly unsophis- ticated inhabitants. There is growing evidence tl'B t Member Countries are iroreasingly concerned with the status of tbair environmental sanita- tion and 'are interested in solving these problems. I ... The Regional Office has been active in ass isting a number'" of Memqer Countries to define existing . problems, in st'imulating progr~ss, in planning for long-range improvement of environmental sanitation services, in helping in specific am immediate problems by assistance . . to projects relating to this field, including fellowships, and by stimulating an interchange of technical information among countries. The basic problems' of many of the countries, of this region maybe summaTized by the absence of long-range programmes and the lack of trained p'ersonnel for planning, implementing and maintaining programmes for the improvement of environmental sani ta tion. 1.5 Health Education of the Public The concept that health education of the public is a respon- sibilityof all health workers rather than just that of a group of specialists, and that mass media and other information approaches are but tools or means toward this end~ ~s continued to be emphasized by the Regional Office during tre reporting period. Further, the belief that health services can best be extended through an approach to the people which takes into consideration such things as their cultural patterns, tte ir i~s about health, their health needs and interests, hB.s also been promoted. The need for' health and medical departments to work jointly with rela ted agencies, groups and individuals for tre education of the people in health, and the importance of involving the people' in all health planning. and implementation has likewise been emphasized as an educational fUnction. It has also been. indicated that if these ideas are to be succes~full.y incorporated in the thinking and activities of health wo:rlrers, than: tre health education skills and understandings which include working with "people must be included in the basic and in-service trainin·g of all categories of health personnel. The idea that every country and teITitory needs a small but highly trained corps of health education specialists who can give dynamic leadership and direction to such a programme has also been stressed, If health education of the public .is to make its full. impact 'on the development of health work throughout the Region, it must be integrated as part of the long-range planning for malth and must . itself have an accompanying long-range plan. It tas also been point edout that these health eduaa tion developments.require a considerable amount 0.£ time. /The Regional ••• , wp/Rch/3 Page 17 The Regional Adviser for Health Education was invited to tre following countries ani territories to provide consultation in the development of realth education: Australia, Brunei, China (Tuiwan), Hongkong, Japtm" Koron, Nothorln.nds NOv1 Ouinea nnd Territory of Papua and New Chdnc a. , Health education fellowships for study in the United States in 1955 have been awarded to a candidate from the Terri tory of Papua ani New.Guinea, ani to one from the Philippines. ·Another was awarded ·to a candidate in Taiwan for a short period of study in Jap3.n. "Direct correspondence for the exchange of technical information between the health education officers of three countries in the:Jtegion and the Regional Adviser has been established during the repdrting period. 1.6 Mental Health Progress in this field is slow; not because of lack of interest in tre Region, but mainly because of the lack of trained persormel at all levels, and the reluctance of graduates to seek service in this particular' field. The fact tInt the concept of mental health is relatively new and that methods ald procedures in this field have not yet beoome well known also oontribute to the situation. Further, it is diffioult to obtain mental-health oonsultants' for a period of time sufficient for them to make a posi-tive impact on the ernrironment in whioh trey are asked to ~work. Naturally the logical and initial approaoh to the solution of this problem is to provide opportunities for' training through fellowships. . Several countries; however, have shown an active interest dur:ing the year under review. A fellow fran Aus't;.~;l.ia is studying clinioal neuro-physiology in Europe and the United States. Two fellowships are provided for Hongkong for studying psychiatry and mental nursing in the United .t\.ingdom. One 'fellow from Western Samoa is working with the psychiatrist of Fiji, who has himself reoently returned from the United Kingdom after obtaining the Diploma in Psychological Medicine on a WHO fellowship. Two fellows in Japan have recently returned after fellowships in psychiatr.y awarded following the visits of two WHO comultants to that country. . Coasiderable interest has been aroused in the development of community mental haspi tals. For example, the Federation oflVlalaya obtained the services of a WHO consultant in community mental hospital development in 1954 and the Government has already begUn to implement his roconnnen:iations. /In Singapore ••• WP/Rc6/3 Page 18 In Singapore, the Government is developing a progressive scheme for t he training of mental nurses and training staff under WHO assistance for the study of child development. In the Philippines, consideration is being given to the provision of community mental hospitals in outlying provinces and arrange- ments are being nade for skilled psychiatric staff to pay regular visits throughout the country ~ In Hongkong, a new mental hospital is being built and the Organization is assisting in training staff for this hospital. The Chief of the Mental Health Section, WHO Headquarters, visited Chinu (TaiWml), Hongkong, Jo..pD.l1., the Philippines and Singapore. In these countri as he was able to contact the participants who had attended tre Men tal Health Seminar held in Sydney in 1953 and consult 'With the Governments on their problems and projected 'WHO projects in this field. . In the Philippines, there is keen interest in the development of a national mental health programme and a new section in mental health is 'being formed. For sane t:ime now the Government has been endeavouring to appoint a director for this section an:! provision has been made by the Organization for a fellowship in public-health mental hygiene whiCh will be. awarded to the person assigned to this post. Further developments in the field of mental health are reported under the Singapore urban health centre project, and in th.e maternal arxi child health section of the report. 2 COMMUNIClJ3LE DIS~SE CONTROL 2.1 Malaria ContrOl Efforts have been made to persuade governments to expand their malaria control programmes into mala ria eradication schames with a view to stopping residual spraying operations before the anopheline vectors develop resistance to the insecticide. This change in the strategy of malaria control has been adopted by the Governments of the Republic of China and the Philippines, where intensive residual spraying operations are in progress. Plans have also been made for malar:ia eradication in Cambodia, where active steps have been taken to train sufficient numbers of local personnel to undertake the country-wide operation. In Sarawak, a dieldrin field trial has been undertaken in addition to the DDT residual spraying operations, while the Government of North Borneo is· starting a malaria project with \£0 and UNICEF assistance in July 1955. The Adlninistration of Netherlands New Guinea is expanding its maJ..aria • oontrol.programme wi th assistance from UNICEF and WHO. Fellowships have been awarded to malaria workers in Cambodia, China (Taiwan), Hongkong an d the Terri tory of Papua and New Guinea in an effort to strengthen /their ••• wp/RC6/3 Page ~9 their respective malaria control organizations. The Second Asian Malaria Conference was held in Baguio City, Philippines, in November 1954, and was attended by 42 participants from 13 different countries. This conference was devoted chiefly to technical discussions. hfter the conference, a visit was made by about 20 participants to the malaria project in Taiwan, China. 2.2 Tuberculosis and BCG Tuberculosis campaigns carried out during the year by governments with the assistance of the Organization, were mainly oon- cerned ~th BCG vaccination, and the programmes in active operation were those in Cambodia, China, the Philippines, and Viet Nam. All four of these were operating at the end of the reporting year with international personnel still assigned to Cambodia" Viet Nam and the Phllippires and . the other being carriod out entirely by government personnel. International assistance has ceased in respect of th e cam- paigns in Brunei" the Federation of Malaya, Hongkong, Sarawak and Singapore and the work is being carried on by th;j respective Governments. The BCG assessment team, after working in a number of countries, finished its assignment in April 1955. Interesting and valuable results were obtained and a final report will be issued after careful analysiR of the data by the TubGrculosis Research Office at Copenha gen. Consolidation of BGG campaigns, in order to ensure continua- tion and to integrate them into the permanent public-health services of the countries, has received much attention during the year both in the Regional Office and at Headquarters. Consultations with governments have taken place on this subject. As the assistan::e of the Organization in BCG campaigns approached its end, an increasing emphasis has been placed upon overall tuberculosis-control projects into which the BCG campaigns will be integrated. Overall tuberculosis-control projects are already in operation in several countries and the assistance of the Organization in sane of than has been discussed in detail and plans have been· formulated. Requests have beGn received from several other Member Countries far the assistance of the Organization in drawing up similar plans. Much investigation and research have taken place during the year on simplified methods for diagnosing tuberculosis and on the best method of carrying out chemotherapy on ambulant p~tients. Both of these are important items in a scheme for tuberculosis control. 2.3 Venereal-disease and Treponematoses The WHO/UNICEF-assisted venereal-disease control project in China (Taiwan) completed tre planned training for health personnel and went into full operation with theo establishment of venereal-disease control activities in all the 22 health centres" 365 health stations land several ••• WP/Rc6/3 Page 20 api several of the hospi tals of the province. More than 250 000 people were examired serologically during the period under review. In the field of yaws control, the WHO-assisted project in Laos was able to resume field operations in August 1954, the WHOjuNICEF-assisted project in the states of Kelantan and Trengganu, Malaya, went into full operation" the WHO/UNICEF-assisted project of tm Philippines continuedto expand and new yaws-control projects were started in Fiji and the Netherlands New Guinea. Interest in a venereal-disease control project was expressed by Laos and this prcgramme· is envisaged for 1956. The Governments of the Pacifio Island Territories, including Fiji" lfestem Samoa, the Cook Islands" the Kingdom of Tonga,· tm British Solomon Islands Proteotorate, tie Gilbez:t and. Ellioe Islands, the Condominium of the New Hebrides, and New Caledonia showed interest in the control of yaws. A yaws-control programme for Western Samoa is plamed to start in August this ye,ar, a mass oampaign and a clinical trial of benzathine penicillin in co-operation wit h 1-rnO has been undertaken in the Wallis Islands by tre Adminis- tration of New Caledonia and tm Regional Adviser on Venereal Diseases and Treponematoses visited the British Solomon Islands Protectorate, the Condominium of tre Ne"I)T Hebrides, New Caledonia, and the Kingdom of Tonga to observe am discuss the probiem w1.th the several Governments and make appropriate recammendationso ENDl1Mo-EPIDEMIC DISEb,SES i Filariasis and ot.her .~nsect-borne :iseases Filar:iasis Increased interest in this disease has been shown during the year under review. Research is proceeding steadily in the Federation of Malaya on the entomological and therapeutic aspects of filariasis control and on the fundamental epidemiological studies of its spread. Similar studies ferm a major researqh activity of tll:l South Paci:tic Commiss ion and SOlie work is also being done in Taiwan • . Recent studies by a m,E.Illber of the staff of tre Johns Hopkins School of Hygiene arrl Public Heal t~, seconded to the Institute of Hygiene in the Philippines under the w!{Q-assis.ted exchange programme and hi~ nationalcO'1lllterpart" show tlR t th~ disease is more widesprea.d in the Philippl.res than hitherto believed. . , A study of these and other researches indicates that tre . problems of control are .manifold" intricate and local and the. t control measurel;l associated with malaria control may bring further problems.: Indeed"., it TNould appear too t it may be some time· yet before filariasis control'measuresrnay be extensively applied •. ITo study ••• WP/RC6/3 Page 21 To study these problems the Organization is sponsoring a small expert study group in the Institute of Nedical Research, Kuala Lumpur, in December 1955 at the invitation of the Government of the Federation of Malaya. 3.1.2 ~rthropod-borne virus diseases The Regional Committee at its fifth session discussed the endemicity of insect-borne diseases in the Western Pacific in relation to the:ir importance and control and reconllnended tha. t II experts in the Region be asked to prepare papers on the public-health aspects of the problem for the consideration of the Expert Committee on Virus . DiseaseS, and if the Expert Committee thinks fit, that a seminar should be held at a later date."l As a result the following experts have presented papers on the subject which was slightly amended as within the spirit of the discussion to "Endemicity of arthropod-borne virus' diseases in the . Western Pacific in relation to their importance and 'control": Sir MacFarlane Burnet, F.R.S. and colleagues from the l;1alter and Eliza Hall Institute of Medical Research, Helbourne, Australia Dr. Masami Kitaoka, Chief, Department of Virology ani Rickettsiology and Dr. Syoziro Asahina, National Institute of Health, Tokyo, Japan Dr. J. W. Field and colleagues, Institute of Medical Research, Kuala Lumpur, Federation of Malaya Professor J. H~ Hale, Department of Bacteriology, University of Malaya, Singapore These papers have been forwarded to Geneva for consideration of the Expert Committee on Virus Diseases regarding the desirability of holding a s.eminar on these problems at a future date. Member States in the Region will be informed of tho recommendation made by the Expert Committee as soon as this is available. 3.2 Poliomyelitis Arising out of a request from the Expert Committee on Poliomyelitis, enquiries have been made throughout the Region regarding the nomination of one or two la.boratorios as regional poliomyelitis laboratories for co-operative studies with other regions and countries in the isolation of poliomyelitis virus and the study of the epidemiology of the disease in the Region. The National Institute of Health in Tokyo has been designated as one of these centres and negotiations are in progress for the designation of another such centre in the southern area of this region. WP/Rc6/3' ' Page 22 4 EDU CATION AND TRAINING 4.1 Assistance to Educational Institutions The year saw various education and training prograrmnes in different stages of growth and development. The mas t fully developed is probably the exchange programme, begun in 1953, between the Institute of Hygiene of the University of w Philippines and the Johns Hopkins University School of Hygiene ani Public Health. Assistance to the University of Malaya ~.J'as also begun in 1953 with the appointment of two WHO-supported lecturers and the provision 0 f some equipment and supplies. The implementation in 1955 of an exchange programme with the London School of Hygiene and Tropical Medicine is still awaiting further develop- mEnt. Assistame to tre Royal School of Medicine, Cambodia, was conunenced in 1953 with the arrival of a WHO-supported lecturer. Full implementation of the project was discussed with the Government in February 1955, and a part of the programme that was concerned with twa short-term fellowships for the Director of the School and a French professor to v:isit medical schools in neighbouring countries, was implemented during the period April to June 1955. Assistance to the Institute of Public Health, Japan, was implemented during the year under review. assistance to the Central Medical School, Fiji, was started by the end of February 1955. Awaiting impleroontation and recruitment of a medical education ccnsul tant is the project for the survey of three private medjc alschools in the Philippines. The Government of Viet Nam has submitted a request for assistance in providing equipment and supplies fur a new school to be established fOr the training of sub-professional medical officers. Still in t he dis cuss ion stage but wi thou t any definite indi cat ion of material- ization is a possible plan of assistance to the Institute of Public Health, China (Taiwan), on the basis of WHA6.35. During the year, the Adviser in Education and Training visited the Royal School of Medicine in Cambodia and while in Saigon was briefed on the plarming of a new school for the training of sub-professional medical officers (health assistants). 4.2 Fellowships Eighty-seven fellowships totalling 667.5 fellowship-months were awarded during the period under review, covering thirty-four fields of study. Their distribution according to fields of study and countries of origin is shown in Annex 5. It may be pertinent to review here the rela ti ve cos t of fellowships as compared with other fonns of educational assistance. Out of a total twelve-monthS' expenditure of approx:Una. tely $326 000 for all education and training projects, including fellowships attached to or independent of other projects, the cost of fellowships amounted to approximately 79%, personnel" inc.ludihg consultants and lecturers, 19%, equipment and supplies, 2%. It may be observed tm t no semimrs took place during this period, the last being in May 1954 and two being schedu;ted for the latter part of 1955. An inter-regional malaria /conference ••• \fP/Rc6/3 . Page 23 conference was held in November 1954, but the extent of the expenses involved in this conference is unknown to the Regional Office. Even if a hypothetical seminar were included at an estimated maximum cost of $50 000, the relative percentages would be: fellowships 68, persomel 17, seminar 13, equipment and supplies 2. Of the 87 fellowships awarded, 29 or 33% were placed within the Western Pacific Region. Placement was also arranged within the ·Region for 25 fellows from the South-Fast i~sia and three from tte Eastern l1editerranean Regions, while four others fran outside the Region have been placed for study to be undertaken later in 1955. Of the to tal, five fellowships were less than three months in duration, three were three to six months, 31 were six ,to nine months, 41 were nine to twelve months, while the remaining seven were travel grant s. Some of thefellowship holders bad language difficulties, so much so that it is doubtful whether they received th9 maJdmum benefit t.hat. might have accrued them, although each candidate was screened by the .government concerned. Some difficulties were also encountered in arriving at a satisfactory study programme for a number who were granted travel fellowships especially when parts of th~ programme were modified and all subsequent dates had to be changed after the original itineraries had been agreed upon. In other cas'es, itineraries had to be changed as a result of unforeseen circumstances, with consequent inconvenience to the institutions or governments already contacted. The co- operation sho~m by the institutions, governments and other regional offices concerned wit h tre stuctr programmes for fellows from this regjion is very much appreciated. 4.3 Educational me0tings The Adviser in .&iucation and Training took part in a sel1.,es of pre-seminar meetings held with three departments of the Govemmerit of Hongkong in connection with the nutrition education and health oducation seminar.. He also assisted in the planning of the! nursing oducation semimr to be held in Fiji in J'.lly 1955, the nutrition education and health cducat.ion seminar to be held in October 1955, and was responsible for organizing the technical discussions to be held in conjunction with the coming Regional Committ.ee Meeting. /PART III WP/Rc6/J Page 24 1 AUSTRALIA PART III - ACT1'lITIES BY COUNTRIES 1.1 Health Education The Regional Adviser in Health Education, together with the Section Chief of the Health Education of the Public Section in Geneva" served as consultants to the First Australian Health Education Seminar held in Canberra in January 1955. At the invitation of the Australian Gaver'nment" the Adviser visited each of the states in Australia during the mcnth of July to assist wi th the conduct of preparatozy meetin~s for this seminar. 1.2 Education and Training Two twelve-month fellOW'ships were awarded in the latter part of 1954 to enable an assistant clinical director of the New South Wales Division of Mental Hygiene to observe work done in neuro-psychiatry in tl'E United states" Canada, t re United Kingdom and parts of Europe" and a senior medical officer of Austin Hospital, Melbourne, to study methods of tuberculosis control and treatment in approximately the same areas. At present they are both in the United Kingdom. A third award was made in May 1955 to enable 'too If.edical officer- in-Charge of a commonwealth health laboratory to take a twelve-month course for the diploma in clinical pathology in the United Kingdom in the latter part of 1955. Part of the travel arrangement s for a fourth fellow has been finalized for the study of laboratory investigation of still- birth" neonatal am infant death and diagnosis of bronchogenic carcinoma in tts United States and. United Kingdom in the latter part of 1955. 2 BRUNEr 2.1 Nutrition August/December 1954 A short-term consultant in nutrition visited Brunei to review the school feeding scheme which was organized with the assistance of the WHO nurse originally attached' to the nursing education project. It was found tl:R t the scheme had been considerably extended since its inception, the number of school-children receiving free meals by 30 Septenber being about 60% more than in May 1954" Community interest had grown as a result of decentralization of the scheme~ which is running smoothly under the supervision of school committees directly responsible to the Medical Department. . 2.2 Malaria Control Project started: October 1953 The Government is conducting a residual spraying campaign.with technical assistance from the WHO staf~ assigned to the Sarawak malaria pilot project. /It is ••• wp/Rc6/3 Page 25 It is expected that in the future malaria-control activities in Brunei will be co-ordim ted with those in Sarawak with a view to --'---"eradicating the disease in the two territories. 3 CaMBODIA 3.1 Public-Health~dministration Project started: Novanber 1953 A WHO public-h::!alth administration specialist· co-or.dim tes the work o.f the WHO and/or UNICEF-assisted projects ~ th that of bilateral agencies. Through agreement between the. Government" WHO and FOil., he and tre other WHO field staff in Cambodia act as advisers to the FOA Mission in Cambodia and afJ FOA advisers to the Government. He is also giving lectures on public health in the Royal School of Medic~ne. A. site is being chosen for a rural-health training centre at whi ch all WHO field staff togethe r with their national counterparts ~illdemonstra.te comprehensive mediml and health services at the . . provincial level. 3.2 Maternal and Child Health Project started: January; 1952 , t. Although tre maternal and child -health project .in Ca.ri:>6dia .' started with most emphasis on paediatrics, during the past year the maternity-care aspect of the programme has received more attention. The WHO medical officer has played a big part in obstetrical teachin~ in tre Royal School of Medicinee With the addition of a public-he~th nUrse to the team, it has been possible to devote more attention to . training nurses far the pre- and post-natal care programme. The W) rk of this tAam has always been closely associated wi. th that of the nursing education project and the addition ofa midwifery te~cher to the nursing team has enabled the two teams to plan improve- ment s in: the rna ternity care, obstetrical and midwifery training given, in tJ:E hospital. . 3.3 Nursing Education Project started: September 1921 Clinical facilities are being developed in co-op'eration with the maternal and child health team. The training pro gramme was handicapped in t~e beginning when services were started before personnel were trained. Refresher courses are being given to improve nursing services in tl::s government hospital and health centre, and a basic school of nursing w:ill b~ developed with'. public health as an integral part of student teaching. A new quonset building and teaching equipment are being provided by FOA. Assistant nurse training is under way and midwifery training is being developed. The Ministry of Education has organized special classes to improve the education~l backgr~>und of nursing stu den ts and as general educa.tion is gradually improved, the standard of nursing education will be raised. When the nursing and midwifery schools are ready, it is planned to brtng studEnt s from Laos for training. /3.4 Malaria ••• \. wp/Rc6/3 Page 26 3.4 Malaria Control Project started: August 1951 Progress has been made in the malaria-eontrol programme during the past year. The valuable observations conducted by the WHO malaria team am. local staff in t re demonstration and comparison areas are b~ing used in tbe expansion of malaria-control activities to the other parts of the country. Training of local personnel has been an important part of "the programme as add itional trained staff is required to cover all the malarious communities. It is estimated that about 400 000 people live in malarious areas in Ganbodia. Work is in progress to protect half of this popula tio n from mala ria in 1955 and in 1956 it is expected that sufficient personnel and materials will be available to cover all the malarious areas. The present programme is being intensified to achieve malaria eradication. 3.5 BeG Project started: 'January 1955 The BCG project began with international assistan::e in January :,',' ,1955 and still continues. In the first three, months, three teams were trained, 34 091 children were tested and 12 705 vaccinated. The campaign is proceeding satisfactorily. It is expected that too number of persons tested per month will soon reach 30 000. 3.6 Fducat:ion and Training Royal School of Medicine Project started: July 1953 This programme received a fresh impetus in the latter part of 1954 with tre development of an affiliation programme between the School arrl,'tre Faculty of Medicine of tre University of Paris and '\he completion of 'anew building for the launching in October 1955 of a seven-year course for high-school graduates. Present requests cover four WHO-supported lecture rs in physiolo ~, pathology, clinical medicine, inc luding phthisiology, and ophthalmology, equipment and supplies, short-term fellowships, and stipends for ten baccalaureate students per class starting with the first ciass 'this' year. The Goverrunent has agreed to a supplementary agr-eement draftedin"april. Signature of the agreement is pending and an order for equipment and supplies will be processed as soon as the requisition is received from the School. The lecturers will be seconded by the University of Paris and appointed by the Organization. Short-term visiting professors and other lecturers needed will be supportedbytlle French, Econondc Mission. The FOa ,Mission in Cambodia has also made substantial contributions to the School. In all other respscts, tre GovernmGnt is supporting the School, and other associated insti tut ions to the bt;st of its ability. Development of national counterparts in specific teaching fields is limit,eel at present by the dearth of profes- sional personnel in the country. Some progress is expected to be made inthis5.mPQrtant conrection only in tre next five to t en years. ::' ... '. /4 CHINA ·4 CHINA 4.1 Maternal and Child Health wp/Rc6/3 Page 27 Project started: August 1953 A medical officer was appointed to the maternal and child health team during the period under review. The filling of this post, which had been vacant for the previous ymr, added impetus to the pr.ogramme as attention is now being given to the training of the medical officers at the health stations in maternal and child health. At the demonstration centre in Taichung tte training of public-health nurse supervisors in maternal and child health work has continued. WHO provided an inter- na tional public-health nurse for this seotion of the teaching programme for as long as the Govermnmt felt the need. During the past ;year her national oounterpart has carried on alone. National personnel have also done some excellent teaching on the nutritionct1 needs of the mot her during pregrimcy and the nursing period. Both the physician and the midwife who have been counterparts to the international team members have gone on fellowship study during' thEiyear. It is hoped that the public-heal th nurse will be able to proceed on a fellowship in the near future. A fellowship for the nutritionist is also be:ing provided and it is hoped tm t thi s candidate will soon be able to start her studies. UNICEF has given a great deal. of assistance in this progrannne whic h has aimed at improving the quality of tre maternal and child health W) rk at the health stations in the countries throughout the province. In addition to allocating funds for further equipmmt to be supplied to the centres as their personnel receive training at Taichung, UNICEF has embarked on a new pro gramme for providing equip- ment for private midwives who will be given refresher courses and supervision by midwifery supervisors trained in Taichung. 4.2 Nursing Education Project started: May 1952 WHO assistance to this project has been continued during the year. WHO nurse educators, with local counterparts, are strengthening nursing education at the National Taiwan University Hospital School of Nursing. In-service training is being given to the graduate nurses and sgecial courses are being conducted for head nurses from government hospitals. Assistance is also ~iven to the govermnent school of nurs- ing in Tainan while local nurses are studying abroad to prepare for teaching positions. Five fellowships have been given to improve nursing service and clirri..cal teaching an d additional fellowships are planned to qualify nurse educators to continue too teaching programme at the University School of Nursing upon withdrawal of international personnel. To help meet the shortage of suitable teaching materials, the following illustrated manuals in Chinese are being prepared through the combined efforts of the WHO nurses and their local counterparts: (1) Nurs ing Arts Manual (2) Hedical and Surgical Nursing Manual (3) Obstetrical Nursing Manual (4) Paediatric Nursing !1anuru.. 'h .. "3 Environmental wp/Rc6/3 page 28 Environmental Sanitatio~ Project star~: October 1954 A WHO short-term consultant in public-bealth engineering was provided for a period 0 f three months to study the organizational. and administrative establishments and their functions. ':'h~l consult,ant' s report covered means of improving and strengthening the national environmental sanitation services and made specific recommendations in this respect. Two WHO public-health engineers will be provided in 1955 to implement the recommenda tions of the short-term consultant, to advise and assist in a pilot project which will demonstrate modern and economical procedures in environmental sanitation and take part in the training programmes for professional and sub-professional workers in this field. Two fellowships will be provided in connection wi th thi s project. 4.4 Malaria Eradication Project started: May 1952 In view of the excellent results of this project, the objective has been changed from the control of malaria to too eradication of the disease. In 1954, the r~uses of 5 467 664 people, representing the malarious population of Taiwan, we~ sprayed with insecticide. In 1955, it is e:xpected to cover approximately the same population, and as of 30 June 1955, abru t ha lf 0 f t hi.. s population has bee n c overed. In view of the development of the project into an eradication schene, WHO assistance has been extended until the end of 1957. Fellowships have been awarded to two ranking members of the Malaria Institute to observe malaria surveillance work - so important in eradication schemes - in the nearby region. To strengthen the Malaria Institute and develop it as an institute for the control of other insect-borne diseases, fellowships were awarded to two other members of the Institute to study tropical diseases and entomology in London. The WHO malariologist of the project succumbed to an illness in May 1955. It was, however, agreed by the Government and the Organization that he would not be replaced, as the Director of the MaJaria Institute could serve as malariologist of the team am, tre Regional Malaria ~dviser of the Organization could provide such additional technical. assistance as might be required. BCG Project started: .april 19,22 The BCG programme continued throughout the year under govern- ment Cluspices. Twenty-two teams were in the field and their WJrk has been integrated imto t he overall tubercu1osis-control programme. The cumulative totals of four years' work up to ~1ay 1955, showed 3 768 0,58 tested and 2 190 197 vaccinated. The BCG Laboratory continues to produce all the vaccine necessary for the campaign. /4.6 Venereal •••• 4.6 Venereal-disease Control ----- wp/Rc6/3 Page 29 Project started: August 1953 Considerable prog ress cont inued to be rna de on this WHOju NrC EF / FOA-assisted project. During the past year the planned training in venereal-disease control for the health personnel for all tte 22 health centres and 365 h~alth stations and several of the hospitals of Taiwan was completed am tre progranune was expanded with the initiation of venereal-disea:se control activities in all .tre se institutions, bringing the facilities of the programme to every prefecture of the provi~ce. These facilities included a serological laboratory service provided by the reference serologioal laboratory and the 20 serological laboratories established previously in the health centres. The first China survey of serological tests was carried out am revealed that all but two of the labora tori.es ope rat ed at a h:igh level of efficiency. During the period June 1954 to May 1955, 231 978 people were blood-tested and 10.9% were found to have a positive reaction to the serological tests for syphilis (STS). 77% of the people examined were from the rural areas and arr,ong them 9.8% were found to have a positive STS as compared with 11% of the people from the urban areas. 8.5% of the pregnant women examined were found to have a positive STS. b. total of 27 320 cases' of syphilis were diagnosed as well as 1641 cases of acute gonorrhea, 484 cases of "chronic" gonorrhea an d 215 cases of other venereal diseases including chancroid and l;ymphogranuloma venereum. 15 933 of the cases of syphilis have been trea ted and it has been considered tha. t the widespread fear of severe reactions to treatment with penicillin, the early stage of development' of the follow-up services and the reporting system for this rather extensive progranune were respons:ible for the relatively large number of defaulters from treatment. Apart from the official health personnel trained, 1016 doctors, 1266 nurses and midwives, 102 medical sbldents and 90 sanitary inspectors reyeived instruction in venereal-disease control and much effort was put into the health education of tee public. Investigative work carried out included tre many surveys, tre examina- tion of reports on cases of severe reactions to penicillin treatment am the serological reaction of a group of lepers to tte VDRL and Kahn tests and the treponema pallidum immobilisation test. The WHO team was completed by the arrival of the serologist and the public-health nurse during the year, rut by June 1955, the whole team tad completed their respective contracts and le it Taiwan. A ~'lH0 venereologist has been recruited to' continue to advise tre Gover rnnent on the prog ramme. Trachoma Control Project started: 1952 The trachoma-oontrol activities started in 1952 as a pilot proje ct. A mo consultant has visited the country on several occasions to assess am advise on ih€ pr egress of th e campaign. /By the end ••• WP/RC6/3 Page 30 B.f the end of June 1955, 1.1 million school children had been . exa.rniA.ed; 55%, of them were found to have trachoma and 20%, conjunctivitis. UNICEF an~ibi6ticointmerit, plus sulfa drugs for resistant cases, were used in: their treatment. Another 240 000 children already in school have still to be examined. In September 1955, 215 000 children will enter school for the first time and in September 1956, another 258 000. About 200 000 hane contacts will be examined as part of a pilot project. By the end of 1956, when the campaign terminates, an estimated total of 2013 million children will have been examined and those diagnosed as having trachoma or conjunctivitis, treated. 4.8 Triple Vaccination This is a project for which UNICEF is giving supplies and WHO, technical guidance. Owing to the delay in the ar!r'i val of imported supplies and the preoccupation of health centre and station personnel with the malaria, venereal-dis~ase control, trachoma and maternal and child health progrrunmes, the number of children vaccinated was considerab~ smaller than the proposed target figure. 5 FEDERATION OF MALAYA .: .. : 5.1 Rural-Health Training Centre Project started: November 1954 #' This project has been plarmed for a period of two years in the first instance for the purpose of establishing a training school for rural- health workers for the Federation of Malaya at Jitra in North Kedah. At this school it is proposed to train teams of four - an assistant health nurse, a sariitary overseer, a midw.i.fe ~d a dispenser - to staff rural- health' Units and sub-units throughout the country. The school will also be used for refresher courses 'for trained medical officers of health and health'Visitors i'n .their responsibilities in the use of auxiliary health personnel~, ' ' The WHO medical officer who is the chief technica.l adviser to the Government regarding the project was sent to the Federation of Mal~a in November ,1954. For various reasons there has been delay in the canpletion of the school and the provision of essent~al services, during 'which time the medical ,officer has surveyed the,' area, worked with the State Medical Department and planned the progrannne. Before the end of the' period under review, however, everything had been completed and the school ready for the first ~i~, teams which have been selected • ..41.1 national staff ar~ also ready and ~t ~s hoped that the second member of the WHO team, C3. public-. health nurse, whose recrlP-tment was d,elayed until the school was ready, will be aV~lable to start t,raining on,l'August i~55./, , , .. ", The mID medical officer and his counterpart are now':rurntshing' the school, opening the clinics, and selecting sites for sub-unit centres. ,'" \ /5.2 Nursipg ••• 5.2 Nursing Education WP/RC6/3 Page 31 Project s~ted: June 1950 WHO assistance to the projec~ has continued and 430 student nurses, hospital assistants, graduate nurses and publie-health nurses have now received training. The educational background of stu;dents has improved to a reasonably good standard of basic educ:ation and to post-graduate courses in ward administration and clinical teaching. Local qurses are gradually bding prepared to take over the teaching posts, ani two \VHO fellowships are planned in 1956 to prepare two additional nurses for teaching. WHO team members have been consulted in regard to nursing and midwifery legisla tion. An organized teaching programme has been established and approved by the General Nursing Council of England and Wales am all student nur ses are required to attend the full schedule of classes. Nursing service and clinical teaching have gradually iropro ved and the re is bett er co-ordination betwee n theory am practice •. Teaching for health nurses has been organized and the course approved by the Royal Sanitary Institute. Midwifery teaching has been established in two schools of mldwifery, one in Penang and the otrer in Kuala Lumpur, wi th fully qualified local midwifery tutors. Auxiliary nurses for hospitals and health centres are being trained by the Government which has established an assistant nurse training scheme for this purpose. 5.3 Mental Health . Community mental hospital Project started: November 1954 development ) This project was started in November with the assignment of a short-term consultant for two months. He completed his work in December am his final report has been forwarded to the Government which. has expressed appreciation of it. In his report tre consultant outlined the essential programme of development required to shape a community mental hospital and mental- real th service as a long-term developnent. He also recommended certain immediate steps to remedy tre urgent situation regarding shortage of hospital accommodation and trained staff. The following are some of the reconunen da tions made by the consultant: '1. Every effo It should be made to recruit for the mental hospitals doctors ani trained nurses of the main social groups.in the hospitals.-':' 2. There should be financial inducement for m-edical officers, staff nurses am sis tars to take 'up psychj.atric work. \. ';';: /3. There •••• WP/Rc6/3 Page 32 3. There should be a systematic plan for the training, over a period of yearsl of such medical officers and nurses and assistant nurses. . .. ~ 4. It is desirable to aim at a psychiatric medical and nursing service largely distinct from the general hosp i tal service. 5. A grade of male mental assis tant nurse should be instituted an d mental assistant nurses, famal e and male, should be a separate grade of staff paid more than assistant nurses in general hospitals. 6. Specially chosen hospital assistants should be considered for training in mental nursing in the United Kingdom. 7. The appointment of a qualified mental nursing tutor and a trained mental nurse for special duties of practical .. teaching and demonstration to attendants is recommended. 8 •. More teaching in the fundamentals of psychology at the under-graduate level in the University of Malaya is recommended. 9. The development of post-graduate teaching in psychological medicine in the University of Malaya is recommended. ' 10. The appointment of an adviser in psychiatry at Head- quarters is recommended. The Government is considering these and other recommendations and is requesting the services of a WHO mental nurse tutor for two years as a fjrst step. 5.4 Yaws Control Project started: April 1954 This WHO,luNICEF":"assis~d project was begun in April 1954 after tre return of the medical off icer-in-charge from an observation tour of the yaws""'Control programmes of In:ionesia, the Philippines and Tlliiland on a WHO fellowship" and has made' satisfactory progress. Two na. tional teams m ve carried out house-t o-hcu se surveys in th3 States of Kelantan and Trengganu and treated with PAM the cases of yaws fwnd and tre contacts of infectious ~ases. Du:cing the period April 1954' to May 1955, 40 674 houses with an. estimated popula tion of 176 452 people were v.lsited am .. :146 673 or 83.1% of. the people were examined in the irutial mass campaign. 36 496 cases of yaws were diag- nos ed - an average prevalence of 24.8%- and 35 429 cases of yaws and 3800 contacts were treated. 2307 houses have been visit ed for a resurvey nine to ~ve 1IlCtl'tJoj,e after tre initial survey and. 9016 or 93.1% of the estimated population were examined. 978 cases of yaws were diagnosed - an average /prevalence ••• WP/RC6/3 Page 33 prevalence of 10.8%. The Government has been advised to cxmsider the introduction of the treatment of the total population of the areas of operation with a high prevalence of yaws. 6 FI~I 6.1 Yaws Control Project started: November 1954 This WHOjuNICEF-assisted project was started in November 1954 wi th the establishment of a serological laboratory in Suva, the commencement of the pilot project in Savusavu and the training of the field teams. As of April 1955, six field teams, each with one assistant medical practitioner (AMP) and one assistant nurse, had completed their training and carried out the clinical and serological survey of more than 95% of the population of 61 communities of the pilot project area. An analysis of the survey data of 2466 people revealed'that the average, prevalence'of clinical yaws for the Whole group was 58.8%, for the 2119 "Fijians 58.3%, for the 156 If other races fl 43.5% and for the 91 Indians; 16.4%;. The first survey' of the pilot project has been completed and the mass campaign was started in Larnbasa, in southern VarlUa Levu and in Kandavu in May, and in the Lau Group and Taveuni in June. Two AMP's from the Cook Is'la:nds have received training on the programme, one in field work and the other in laboratory techniques. The Fiji yaws-control project was the first part of an inter-country project and in June/Juiy the WHO te<m moved to Western Samoa'to assist the Government to establish the yaws-control project there. 6.2 Education and Training Central Medical School Project startedl February,1955 Two lecturers from New Zealand, one in pqysiology and ano,ther in biology, arrived in Fiji tovrard the end of February 1955. 'The ' physiology lecturer ,was also responsible for teaching biochemistry and, , pnarmacology. A letter of appreciation from the Principal of the Scho'61 gave indications of the impetus their presence had created. The important part p1CWed by the Medical Faculty of the University of otago in recruiting the two lecturers has been much appreciated by the Organization and it is hoped that the University will continue to take an interest in this " , programme. A requisition for equipment and supplies has been received and expedited and a further requisition toward the $4000 earmarked for this purpose is expected. /7 HONGKONG WP/Rc6/J:' . Page 34 , 7 HOIDKONG 7.1 Maternal and Child Health Project started: April 1953 In Hongkong where domiciljary midwifery has been part of the pattern" the maternal and child health team has also stressed the maternity care programme, particul.a.rly the pre-~tal clinic work where much emphasis has been Place.d on nutrition am health education. The WHO public-health nurse and her counterpart have made an excellent contribution in this ., field. The project has unfortumtely been without an international medical officer for the whole year', tnt the national counterpart has continued to give good supervision of the midwives, a duty which was ,- designated to her by tte Medical De~rtment. 7.2 Health Education The Hongkong Department of Education invited the Regional Adviser in Health Education to make anassessmen t of the school health education programme. As a result" a twelve-months' demonstration" utilizing nursing personnel from the llliO maternal and child health project, the Health Department, ani the Education Department was established.. The GovernmEnt also agreed to conduct an evaluatiOn conference of this demonstration at -the end of 1955 and has requested the services of 'the Regional Adv1ser in the conduct of this conference. . 8 JAPAN 8.1 Maternal and Child Health Ortho~dically handicapped children Project started: November 1952 ,', The first country assisted in the care of orthopaedically handicapped children was Japan. During the past year t re second consUl t- ant provided in the WHO project vis ited Japan to advise on the occupa- tional therapy aspect of the programme. The last of the fellotqship studies assoQiated with the project have beun completed and the fellows' are back working in their own country. It haabsen suggeste4 tha t the Orthopaedic Hospit'al where these fellows w:>rk and which has received. .so_ much WHO assi~ance should become a regional demonstration unit. This might be possible in the future when the local training of· the members of the different disciplines concerned be,comes establish:ld. 8.1.2 Premature infants Project sturted: November 1952 In Japan WHO has provided some assistance in one section of midwifery training under the premature -infant care project. Domiciliary midwifery is part of the pattern in this country and the Red Cross Maternity Hospital trains a big proportion of the ,midwives who work in' /tre field. WP/Rc6/3 Page 35 the .f.ield. The WHO project facilitated the establishment of a good teachipg. unit for the care of prcmatur'e babies in this hospital" uno,er the direction of the WHO fellow who received training in New Zealand and Australia. She ha s also improved the pre-natal care programme jn the hos pital. Further developnents a~ a result of the WHO project will carry the teaching of the home care of premature infants by midwives am public-health nurses into a wider field. The Setagaya In:fl:m.ts Home Premature Infant Care Uni t, which was partly equipped by HHO, will be used in the training·, of public-health personnel. The Director of the Setagaya Infants Home has taken up his WHO fellowship which will enable him to bring himself up to d~te with developmen ts in otrer countries. 8.2 Nursing Education The Government is establismng an education programme in the Institute of Public Health for the training of teachers in clinical nursing, midwifery and public-health nursing. The duration of the course will be one year, WHO is providing one nurse educator for a p~riod of three years to assist the Government in developing teach~ , training programmes. Plans for the project have been drawn up duri:ng ~he; period under review ani fie ld activities will start about 1 August 1955. 8.3 Envi ronment al Sanitation • The hygienic collection and disposal of wastes, particularly in connedtion with pail collection systems for human wastes, has been recognized as an increasingly important problem of public health in Japan. Too Government has encouraged research and field tr:ials in an organized effort to provide solutions to t'his problem. Assistance is being given to the Government in a project for rapid composting of human excretamd other organic refuse. This project includes the construction and operation of a pilot plant which began operations in January 1955 and will be followed by the cons- truction ani ope~ation of a prototype full-scale plant, the design of which Vfill be based on experience gained in studies of pilot, plant operations. An expert consultant will be furnished by WHO as well as a limited amount of equipment and supplies 'IIi three fellowships for advanc ed study on public healt h aspects of wastes disposal. 8.4 Education and Training 8.4.1 National Institute of Herito.l Health Project started: June ,1953 , , The Japanese. workers who retUl?n·edafter studying abroad urrler WHO auspices-·aremaking the contributionse:xpected of them in research and in demonstration and teaching. WHO medical literature /contirmes ... • WP/RC6/3 Page '36 continues to arrive at too Institute. Considerable material written by the institute . staff is appearing in Japanese techniJal publications. 8.4.2 Inatituto of Public Health " Proje ct started: ,June 1954 The ~plementation of this project, the agreement for which was signed in June 1954, was started late in the year with a requisition for, bo&ks. Other requisitions followed in 1955. The Profes sorof Epidemiology from Harvard School of Public Health was invited by the Organi Zoation to serve as a co nsult ant and to oonduc t a cour se a t the Institute during the period March to May 1955. 9.1 General During his vis it to the Republic of Korea, too Regional Public Heal th Administrator was giiT~n an excellent opportunity to exchange views on assistance with representatives of the UtP- ted Nations Korean Relief Ageooy, the Korean Civil Assistance Command, the United Nations Economic Co-ordinator and some of the thirty vOlUhtary agenaies, among which the American. Korean Foundation is the largest. The responsibility far soeial affa:irs has been delegated to the l'1inistry of Health which is now called tre Ministry of Health and Social Affa:irs. 9.2 Midwifery Traini~ A plan of operations has been approved by WHO providing for UNICEF midwifelZY kits and equipnent for midwifery training. The American Korean Fouridqtion is also participating in the project. Technical supervision is provided by the Korean Civil Assistance Command and no WHO personnel are involved. 1 ,." Education.and Training Assistance has bet::n provided by the Organization in the fields of public-health administration and en~ronm8nt~ sanitation throut.h the award of fellowships. ' ' 10 LAOS 10.1 Treponematoses Control Thi s WHO/FOil.-assiste~ proj ect was able to' resmne activities in August 1954. During the period July 1954' and June 1955, the two field teams visited 386 villages with an -estimated pqpulation of 49 336 people of whom 46 730 or 94.7% were examined. A total of 2114 cases, of ,yaws were diagnosed and treated with PAM - an average prevalence 0~4.5%; 337 contacts were also treated. /Since the ••• wp/Rc6/3 Page 37 Since .the start of the project in il.pril 1953, a total of 943 villages have been surveyed with an estimated population of 117 016 people of whan i60 808 or 90.8% were examined. A total of 8447 cases of yaws were diagnosed and treated - an average prevalence of 5.25%. 1402 contacts were also treated • .lU.though the campaign has been carried out with limited resources and under difficult conditions, it has been possible to evaluate the endemicity of yaws in Savannakhet province with some precision, to treat the inhabitants of the remo'Wst village and to train tre local personnel to carryon tre work. Since January 1955, the local teams ha. ve carried on the programme unaided, bl t a WHO expert has been recruited to assist the Gover'nment on the programme and also on the venereal-disease control progral1l1le proposed by the Government. 10.2 Education and Training . l~ssistance has been provided by the Organization in the fields of public health and maternal and child health through the award of fellowships. . 11 NETHERLANDS NEW GUINEA 11.1 Malaria Control . The administration of Net.herlaoos New Guirna has been under- taking a malaria pilot project since 1953, and row that sufficient information has been obtained, plans have bmm made by the Government to expand the malaria.o.control programme with WHO and UNICEF assistance. In 1955, the Government expects to spray the houses of 60 000 people wi th insecticides. The population to be protected f).'om malaria will be increased to 100 000 in 195~, 150 000 in 1957 and 200 000 in 1958. UNICEF has agreed to provide insecticides, sprayers, trans- port, am laboratory supplies and (3quipment costing approxiIm tely $43 000 during 1955 and 1956. The. Organization will continue to provide such technical advice as may be needed by the project. Yaws Control ,. Thi s WHO/UNIGEF-assisted project was started in April 1955 on tre return of the head of the Yaws Section of the Department of Health from an observation tour of;th3 yaws-control programmes of Malaya, the Philippines and Thailand on a WHO fellowship. The national team has been engaged to date on the pilot project on Sentani Lake. During b.pril and May 195.5, 7537 or 99.7% of the estimated population of 7565 of the area of operation were examined. 941 cases of clinical yaws wera. diagnosed and treated and the ·residue of the .... /population • •• wp!a,Gf>/3, Pag~\'3a: '" pop~tion, 6495, were also treated as latent cases and contacts. It is to be mted tl:B t 'the area 'has been tre site, of a malaria-control pilot proj~ptand, tl?. s thus received previous medical attention. , : ';." 12 NE\i ZF.A1AND 12.1-Education and Training Two fellowship awards were made in December 1954 to enable tre Director of the National Health Ins ti tut e to .;tudy virology for twelve mcnths in Australia, and,tre Deputy Director of Nursing of the Departnent of Health to stuqy nurslng education am public-health nursing for ten mcnths in the United states and possibly also the United Kingdom. Arrangemerts' are being ma,de for their p1a~ement. 13 NOR TH BOR NJlX) 13.1 Nursing Education ,Project started: June 1950 WHO nurse teachers have' carried on training programmes for the staff in two gover1'll1ent hospitals, th e health centre in Jesselton and for domiciliary midwives. The outstanding accomplishment is the establishment of a basic school of nursing with student status for nursing stUdents. The Gov,ern- ment is assuming respons iliility for the continuation of thet'eaching programme"when tre international team loli thdraws in September 1955. 13~2:"'" Environmental Sanitation Projeot started: De~emb.er 1953 The GovGrnmerit has mOOe considerable progress in the .implementa- tion of sound long-range plans for reconstructing those coastal co~ties which suffered extensive war devastation. . WHO has assis ted the Government by providing a s,hort-t erm expert consultant on public-health engineering who studied, and advised on plans for water supply and sewage disposal. Two WHO public-health engineers have been engaged in making detailed surveys, plans, designs, cost estimates and specifications for sewerage systems. Detailed plans for the sewerage system for Jesselton have been completed as .well as standard plans for all pumping stations am treatment facilities, Work is urider progress on the other selected c.ommuni ties, incl¢irtg hydrographic studies at proposed sewerage outfall s1tes. Prelimina,ry schemes for thre.e addi tiooal towns have been -completed, A government engineer;is now abroad on a WHO fellowship, far observation and st1!dy of environmental sanitation. The two WHO public-health . engineers are als 0' aSSisting the Government on a programme' which includes planning, design, ;installation, /operation ••• r !'-- WP /F,iC6/3 .. Page 39' operation and maintenanc.e of simple sanitary facilities for rural communities of North Borneo. This programme, which is being assisted by UNI CEF wh:ic h is providing equipment arid supplies I is now in the pilot stage. Various designs for water supply and excreta d:isposal facilitiss to meet varying topographical and cultural patterns rave been completed and are being implemented in three pilot communi- ties. 13.3 Malaria Pilot Project This project is scheduled to start in July 1955. The"' Organization is providing two international staff, analariologist 1;!nd an entomologist. UNICEF,. on tho other hand, is providing approximate).y $14 300 worth of supplies and equipment during the first two years of opera tions. 14 PHILIPPINES 14.1 Public-Health Administration This project is planned to commence late in 1955. and active .recrui tment is in progress for a pub1ic-health administrat'or with experience in the training of public-health personnel. The objective of this project is to assist the Department of Health in the plannin£ of new projects related to health and to co- ordina te all the WHO-·assisted.. prOjects in operation. The public "il,ealth administrator will also act as. liaison officer between the Regional Office and the Department of)Iea1th; will serve as executive secretary of the Public Health Programme Go-ordination Committee; will work closely wit h the officer of the Departme nt of Health in charge of international assistame, ani with all bureau and division chiefs; will review and report on the personnel training programmes of the Depart- ment of Health and Manila Health Department, and assist in strengthening these programmes by working in close association with the Chief of the Personnel Training Section and with the representatives of otrer agencies interested in this field.' 14.2 Maternal alii Child Health WHO assistance has be8n given for maternity care, both in tre health centre services and in training programmes. l1.5sistance in maternal and child he~th training was given first in the rural health d.em.onstration tmin:ing project at Queaon City, where the natioml counterparts have been continuing the programme for the past fo~ years, and then later in the domiciliary obstetric and prematllI'e' infant care project of the Hanila City Health Department. The Manila City Health . Department 's Premature Infant CCire Training Uni t at the .Fabella Health Centre was fornially opened on' . 11 June and tre training of midwives and public-health nurses has /been ••• WPidC6/j~[ Page 40 been pr.oceedi~ since the beginning of the. year under the direotion of the doctor and nurse-midwife who received WHO fellowship training in the United Kingdom. Equipment and supplies have been given by UNICEF • . . ~3'Midwifery Training Project started: October 1953 starting in 19.54, a training programme for public health nurse supervisors from five regional training centres was planned in co- operation wth the Division of Personnel Training of the Department of Health. The ,public health nurse supervisors who have received special midwifet'y training by the WHO midwife teacher are in turn training .too staff in treregional training centres and the staff a~e teaching and supervising tre village midwives or 11 hilots" • 'UNICEF is supplying teaching and midyJifery equipment. This project is closely tied in with the goverrunent reque st to UNICEF for equipment for lklalth centres, maternity houses and maternity hospitals. 14.4 Environmental Sanitation Ehcouraging progress is being made by tre Philippine Government in strengthening national and local environmental sanitation services. PrOfessional post-gradua tetraining of sanitary engineers at the .. lnstit'l;1te of Hygiene of the Uniyersity of the Philippines was initiated:i,n 1954 anc;ipas continued through 19.55. This training programme has been as~isted by the prevision of a WHO visiting professor of· sanitary engineering in collaboration with Johns Hopkins University. A WHO public health enginet.:r arrived in the Philippires in. Ju~ 19.55,for a two-year period to act as technical and administrative adviser to the Government on p!'oblems of environr.J.ental sanitation. He also devotes a portion of his tima· to ~dvisor.r and teaching duties at the Institute of Hygiene. 14.5. Schistosomic.sis Control Pilot, Project Project starte~: June 19.52 The secorn. year of thjs long-term project has~en{levoteq to tm study of (i) the different aspects· of the epidemiology bf the . disease; (~) tbebiology and ecology of the intermediate snail host (On,comelania quaqrasi); (iii) the expermental. envirorunental control in tne .. sele cted hyperendem;ic area in eastern Leyte. Evaluated in terms of the principle objective of tre project it can besta:t~dthat it is progressing very satisfactorily through successi-we steps of exact d.e;finition of the existing situation, amlysis of the causative factors arising from different sources and too study of control:m~aaures 'based on thelmow;tedge gamed of the st.rategic points at which ,trey may be' applied,towards'the determination of the mS.t; effecti wand economical means ;,of controlling schistosomiasis intlil philippine~. ".' .c. /There is ••• , . ..,-' :; - . wp/RJ;6/3 Page 41 There is a growing conviction amongst. the workers of the project that the solution of the complex problem of schistosomiasis lies in a co-ordinated effort of th8 many disciplines involved and that every effort should be made to enlist the co-operation of the different governmental agencies and organizations who could contribute to the solution of the problem, important amongst them being the agricul t1ll'e, irrigation, drainage, public works, education and the ccmmuni ty development councils. 14.6 BCG ~ject started: NoveIriber 1952 This proje ct has oontirru.od throughout the year and too target date has been extended to 31 DeceIriber 1956. A senior adviser was as signed to the proj ect by vJHO for three months in 1955 during the temporary absence of the field director, who will return in September 1955. Plans are being madetoconsoli.date the campaign by integrating the work wi th the rural health uni ts. Up to 30 april 1955, 5 059 319 children had been tested and 2 245 426 vaccinated. 14.7 Treponematoses Control Project started: AUgQst 1951 This \-JHO/UNICEF-assisted project continued to progress with tre extension of tre "integrated prograrrme ll to seven provinces, i.e., Occidental Mindoro, Palawan, Negros Dcciden tal" Romblon, Capiz, Pangasinan and the Hountain Provinces, the continuation of the mass campaign and resurveys in Surigab, Davao, Zanboanga del Sur, Catanduanes, Zamboanga del Norte, Cotabato, Sulu, Zamboanga City, Basilan City and the continuation of resurveys in the pilot project area of Leyte and Samar. During the past year 653 011 people were surveyed, 51 152 cases of yaws were diagnosed and treated together with 20 214 contacts of infectious cases. Since the start of the programme in August 1951, a cumulative total of 2 923 875 people have been examined, 155449 .. cases ·of yaws am 43 917 contacts have been treated, The prevalence . of the disease has been found to be from 3 to 5% with some foci of relatively high prevalence. The integration of the work of the programme has been proceeding and the development of the rural-health progranme of the cruntry is expected to play an important part in making this fully effective. . 14.8 Leprosy Control .;. This project has been planned· to start in July 1955. There are no WHO personnel in the project Which is being carried out under the direction of the Chief of the Leprosy Divi sion 0 f the Department of Health. /The objectives ••• WP/RC6/3 Page 42 .. \. . The objectives of the project are in two stages: 1. Atrial project: To train two teams consisting of one physician" one nurse, one laborat ory te chnician, and one driver-helper. The team will act as travelling skin clinics in areas of high endemicity to: . (i) search out and initiate treatment of cases of leprosy and undertake careful examination of their contacts; ,,-(ii) determine those cases which should be referred to a leprosarium, and those which are suitable for damiciliar,y isolation; (iii) train local health personnel in the provinces in the early diagnosis and treatment of leprosy, particularly with su.'.phones; (i v) e~sure proper follow-up treatment and surveillance of cases discharged from the leprosaria; (v) arrange appropriate measures for children of leprosy patients~ These teams will work closely with the provincial health staff and hand over the follow-up work to them, visiting at regular intervals to make re'surveys.· 2 •. Second stage: If the pilot trial proves successful and effective, and when the administrative difficulties have been ironed out, more teams will be trained to effect a nation-wide coverage. 14.9 Education and Training Institute of Hygiene 1 University of the Philippines Project started: July 1953 The exchange programme between the Institute and the Johns Hopkins University School of Hygiene and Public Health, Which is sup- ported by the Johns Hopkins University, the Rockefeller Foundation and the Organization, under the Technical Assistance progr~e, continued during the year to the satisfaction of all parties concerned. Agreement was reached to extend the project from ·1955 to 1957, with the Organization assuming responsibilities only with respect to consultants (except internal·travel) and international travel for the Johns Hopkins! junior professors and dependents, the Johns Hopkins University with respect to the salar,y of the seconded personnel, and the Rockefeller Foundation with respect to fellowships, equipment, supplies and local costs. . Johns Hopkins' professors of microbiology and sanitary engineering visited the Institute during July and August 1954 to serve as short-term consultants and they were preceded by the junior professors of parasitology and bacteriology who stayed for the academic wp/Rc6/3 Page 43 year 1954-1955. The associate professor of sanitary engineering stayed for a second academic year. All three and i,reir families left shortly bef'oretre academic year ended in May 1955. Dlring the same academic year" the lnsti rute's junior professors of parasitology and public health engineering went to Johns Hopkins as the last two WHO fellows on this pr~ramme and 3.S "visiting instructors". ~.ssurance was given by the Dean of tre School of Hygiene and Public Health that trese "visiting instructors", as well as those who preceded trum, contributed subs- . tantially to the teaching program:ne at Johns Hopkins while at the same time they were given an opportunity to pursue advanced studies. Books, journals, slides, movie films and other equipment, amoUnting to appro- ximately $4000 were supplied by the Organization for the academic year 1954-1955. . June 1955 saw tho arrival of the Hopkins' professors of epidemiology and parasitology as consultants for the academic year 1955-1956, and Un t of an associate professor of public health nursiz:g who will stay for three to frur months in connection with the first post-graduate course offered to college nursing graduates for trainiz:g in public health nursing. The Dean of the School of Public Health and H:ygiene at Johns Hopkins Has also in Manila in June. An associate profe~sor of epidemiology ani plblic health administration is expected ~~~~. . ' .. An understanding has. been reached between representatives of both Universities, the Rockefeller Foundation and the Organization, for the further extension of tru assistance progranune to 1959" with the Rockefeller Foundation sharing th d major responsibilities includ:ing also trn salary of one consultant and the interm tional travel for one seconded junior professor and dependert e, and the Orgsn:lzation beirg responsible for the other consultant and junior professor in each of the academic years 1957-1958 and 1958-1959. Medical Education Survey This project for a survey of the medical educational system ani facilitiae of two private medical schools in and around Manila" wi th a third added later, involves only the recruitment of a hi~y qualif:isd medical-education specialist by the Organization" w:ith the local cost shared by the three schools.. 1>.. letter outlining the terms of reference of the project was addressed to the Government in May 1955 as prospects for implementing a Priority IT project under Technical Assistance became brighter. By June the possibility of recruiting such a specialist by October was also in sight. Gavernnen:t approval of the selection is expected presently. /15 SARA,WAK WP/rtJ;6/3 Page 44 . -', \ \' 15 , SARAWAK Epyironmental Sanitation Assistance'was given to the Gpvernment on technical problems of water supply and treatment by the WHO visiting Professor of Sani,tary Engine'ering at the University of the Philippines as' well as tre Regional Adviser on lihviromental Sanitation. ' , ' 15.2, ,Malaria, Pilot Project Project started: July 19'52 " During the year, malaria-control activities have been extended , 'to th¢ First Division of Sarawak where the dieldrin field trial was under~ken., In this trial, the houses of 12 913 peop~e were ~prayed with dieldrin. Spraying operations with DDT were also conducted in the Baram District where a total of 33 villages with a population of 5974 was given prot ection a gains t malaria. 'the amount of four million Malayan dollars has been voted from the Colonial Development and Welfare Fund an:l this is being used 'by ,the Government during the next five years in the extension of the maiaria';' control activities to the other parts of the country. ' ;' , ',,',' ' 'The WHO- project leader unfortunately became sick and had to be reassigned to another area. A replacement is now being arranged. It is also proposed to assign another malariologist to the prpject, starting in 1956, to assist in the extension of the work to all the malarious conmunities. WHO assistance to this project is being extended up to the end of 1957. 16 SINGAPORE , , 16.1 Urban Health Centre The planning of this project has been'proceeding 'since ;1953, and will commeme late in 1955. Tba new urban health centre, cons- tru~on of which has canrneroed,will be completed late~ 1.956., 'The objectives of this project are: , ,; 1. -40 provide ~~ ternal and child health, dispensary, school .... :,.; .'~' : ...... health, including dental health, and health education services to a pop)llation of appro~tely 125 000 people . ( 'li~ ,in the Vici~t;Of the centrrch will: ' (i) serve as a training field for Under-graduate medical and post-graduate public health students of the University of Malaya, including students £rom otmr countries in the Region, and also for the training of health visitors, health inspectors and other ancillary personnel; /2. To develop ••• wp/Rc6/3 Page 45 2. To develop and organize, by the appropriate authority, training courses for the categories mentioned'in paragraph (i) above. In addition to these services, t~ centre will also include tre Depart-· ment of Social Medicine and Public Health of "the University of Malaya, the staff of which will participate in its training activities. Facili ti es will be made available for the training oflOO· under-graduate and post-graduate medical students, 40 health inspectors annually, assistant health nurses and midwives to t he number required and other ancillary health personnel. There will also be an almoner service. / WHO will provide one consultant in child developnent in 1955, one consultant in public-health nurse training early in 1956, one mid- wife teacher' for two yoars in 1956 and one public-health nursing tutor . tor three years from 1957. In addition, three fellowships will be provided for a period of two years each in child psychiatry,. child psychology 8.Xld psychiatric social work so tl:Bt there will be available trained personnel for the study and teaching of child development. There will also Qa one fellow- ship for a period of one year to prepare a local public-health nurse to continue the programme in public-health nurse training. The Government will fully staff and equip the centre. 16.2 Nursing Education Project started: June 1952 . . WHO assistance to the Singapore School of Nursing started in 1954 lii. th one sister tutor. il. second tutor will arrive in August 1955 am a third tutor will be recruited for January 1956. The. Government plans to increase the teaching posts to ten. The Government provides all teaching facilities and fellowships to prepare loca*·~taff for teaching .po.eitions. In addition to the rapidly growing School of Nursing, there is a.large staff of trained nurses whose basic training is less good than the present students. WHO assistance is intended to strengthen the basic teaching programme; refresher training for staff. nurses will improve nursing services. Special courses will be giv'en in ward administration ani clinical teaching, local nurses wili be prepared for further training as tutors, am assistance w:Lll be given in the correlation of theory and clinical praotice. 16.3 Education and Trainin~ 16.3.1 University of Malaya Project started: October 1953 The two lecturers in I1Edical statistics and applied physiology continued to teach at the Department of Social Medicine and Public Heal the The service of tre lecturer in applied nutrition was tenninated in July 1954, and tha t of the lecturer in medical statis tics at t he end /of June 1955. , WP/RC6/3 Page46 ,,' of June 1955. Procurement for equipment and supplies was completed with part of the funds carried over from 1954. Three fellowships were awarded' to members of the University, of which two in applied physiology and virology are to begin in tre latter part of 1955, and one in preventive dent is try to begin in 1956. Four fellows were sent by too Organization tci join the course for the Diploma in Public Health a t the Uni~ersity for the academic year 1954-1955. One failed at the end of the first tenn, one was pennitted to continue as a special student, and two failed at trefinal e.xamination • . , The propos ed exchange programme between the University and tre London School of Hygiene and Tropical Medicine was agreed to in principle by the two institutions as well as tr1ElOrgani zation. Its implementation in September 1955 presented problems of secondmcnt by the London School .. even though it was understood tm t the salary and travel of the lecturer concerned would be the respomsibility of the Organization. It is hoped tha,t these problems w.:PJ. b,e resolved in the next few monthS. The University was also unable to send one of its staff to London this year. ,17 TEERI'roRY OF PAPlJiI. AND NlM' GUINEA ,17.1 Malaria Control The Organization is interested in assisting the Administration of the TerritOry ot Papua and New Guinea in undertaking a malaria-control project. A fe~owship has ,been awarded to provide further training for a government staff manber assigned to the malaria school at'Minj. It is 'un(ier~'Good, that WHO assistance in a malaria project will be requested " alf~ soon,'as a malariologist can be employed by the Government .:. "', 18,', vm NAM 18.1'; ~ic-Health Admizlistration Project started: (A) February; l~~/JUM 1953 (B) October 19 A WHO public-health administr'J,tion specialist is assisting the Government in drawing up long-tem 'plans for health services am at the same t:ime co-ordim tes the WHO and/or UNIC EF-assis ted BCG, maternal and child health, and Children's Hospital projects with those of bila. teral agemies. J.... public-health engineer is also under recruitment. for assis tame to tre Government in creating a national environmental sanit ation serv:ic.e. Maternal and Ch.ild H~lth Project started: December 1954 , ,This project, which e~at'ienceda number of difficUlties in its early stages, is n~ beginning to ,~how signs of taking root~ A /medical ••• ( wp/Rc6/3 Page 47 medical officer and public-health nurse were ass;igned to lerk with the Government during the period under review. As in Cambodia, it was the paediatric aspect of the progranune tta·t was at first more willingly accepted in the country, but during the pa.st two months it has also been found that there is a desire to improve tre maternity services. Funds have been provided through P~ericah aid for the establishment of tre maternal and child health clinics, which were proposed.in the plan of operations. The Government has submitted to FOA a request for assistanc in the training of rural midwives and the i\Jl1erican aid pErsonnel have indicated tha t they would like to co-operate with \.JHO in developing such a rural mirlwifeIY training progranune. It would, of course, take time for thl s to be established and it is probable tha t WHO would need to recruit another nurse-midwife to supervise this aspect of the IDrk. The WHO medical officer's experience in rna term ty care programme has been very wide and it is pleasing to find that the Government is wise enough to make use of her qualities. '''18.3 BCG . Project start~: March 1954 The proje ct began, after some unavoidable delays" _in March 1954 and has continued <hring the reporting year. i\,t the. end of April 1955, 312 656 children had been tested and 107 558 vacc im ted. It has been agreed to continue th,) services ·of tmint ernational personnel to 31 '. Decenber 1955 .. 19 INT EFt-COUNTRY PROORIJ1MBS 19.1 BCG Assessment Team In this ,project, which ended in hpril 1955, a team of scientists specially trained in Copenhagen carried out tests to evaluate BCG vaccination campaigns and to obtain new infcrmation about tuberculin testing am BCG vaccine. Trey ~rked in Cambodia, China (Tai'¥an), Indonesia, the Philippines and Viet Nar.J., and the f:tnal. report of the scientific aspect 'of the w:>rk will bE; issued by the Tuberculosis Research Office. 19.2 Dental Health Seminar The provisional report of this successi'ul seminar. was received during the year. The final report is still awaited. There has been much increased interest shown in this field since the seminar. The Government 'Of the Philippines has requested tm services of a dental-realth consultant ~or ttree months to advise on a rural dental programme and two fellowships for senior officers to study programmes in other countries .. /The Government ••• WP/RC6/3 Page··4~! The Government of the Federatio~ of Mal~a has received a short visit from a dental-health consultant who was proceeding to In40nesia from the South-East Asia Regional Office. The Government of Singapore has re~ested the services of an expert in preventive dentistry to advise on a teaching and research programne,· also a fellowship for one of the teaching staff to stuqy preventive dentistry in otago University, New Zealand •. The Government of Hongkong has also expressed interest in the visit of'ashort-term consultant • . There has 'also been increased interest shown in dental health in schools in China (Taiwan). Arrangements are being made to meet these requests as part of an inter-country programme in dental health. 19.3 Smallpox Survey JUll-November 1954 The WHO short-term consultant visited Cambodia, China (Taiwan), Hongkong, J~pan, Korea, ~acao,.North Borneo, the Philippines, Sarawak, Singapore. anctViet Nam during the last quarter of 1954. During the Regional Committee Meeting in September 1954 in Manila, he conferred with the representatives fram the Member Countries in this region which could not be incluied in his survey_ His reports on the individual countries and territories visited are being sent to the responsible health administra- tions for stuqy. 19.4 Nursing Education Seminar .. ' :PlanS: for the nursing education seminar, ~lhich is to be held in Fiji in July 1955; were completed during the period under review. Fifty-thr-ee nursing participants and discussion leaders from twenty countri'es' in the Region will attend the seminar. Further' details have been given under the Nursing Sect:i.on in Part 'II'of .this report. 19.5 Nutrition Education and Health Education Seminar In an attempt to improve the basic understanding of health education in the Region·and to stimulate the exchange of· ideas about health .education .. methods and techniques, a ,JlUtritioneducation and· health education seminar is to be held in October 1955 in the Philippines:. This seminar will be sponsored jointly by the Food and Agriculture Organization (FAO) and the South-East Asia and Western Pacific Regions of WHO. Nutrition will be 'used as the focal point for dis-cuss.ions and demonstrations of' health education .principles; methods and techniques. A FAO nutritiomstandWHO health educator have together visited most of the countries in the Region to conduct preparatory meetings for the seminar. The purpose of these meetings was to discuss ,·the: health education programmes and activities in the countries and to collect ideas for the seminar discussions. /19.6 Statistics •.•• 19.6 Statistics Training Course wp/Rc6/3 Page 49 Negotiations for the statistics training course for French- speaking countries are making slow but satisfactory progress. It is expected that the course will take place in the last quart8r of 1955. LIST OF REGIONAL OFFICE POSTS ORGANIZATIONAL UNIT OFFICE OF REGIO~ DIRECTOR Public Information BUREAU OF HFil.LTH SERVICES Advisory Services Fellowship3 Secretarial pool for Advisory Services OFFICE OF ~MINlSTRhTION boND FINAN CE Budget, Finanoe an d accounts I - Internationally recruited L - Locally recruited POST I - Regional Director I - ~dministrative assistant L - Secretary I - Public Information Officer L - Information Clerk L - Secretary I - Medical Director L - Secretaries (2) I - Regional Public Health Administrators (2) I - Regional Adviser on Health Education of the Public I - Regional Malaria hdviser I - Regional Tuberculosis Adviser I - Regional Venereal Diseases Adviser I - Regional MCR Adviser I - Regional Environmental Sanitation Adviser I - Regional Nursing Adviser I - Regional Adviser on Education & Training L - Fellowship assistant L - Secretary L - Clerk-Typist L - Secretary (1) L - Clerk-Stenographers (6) I - Administration and Finan ce Officer L - Secretary I - Budget & Finance Officer I - Finance Officer I - Chief l~ccountant L - l1.CCountant L - lLssis tant hccountant L - Accounts Clerk L - Budget Clerk L - Cashier L - Clerk-Stenographer wp/Rc6/3 Annex 1 NAT IONi\.LITY China Uni ted Kingdom Philippines Cuba Philippines Philippines Philippines philippines China and United Kingdom Canada Philippines United Kingdom Uni ted Kingdan Australia United States New Zealand China Philippines Philippines Philippines Philippines Philippine s Norway United States U ni ted Kingdom United Kingdom China Philippines Philippines Philippines Philippill3 s China Philippines /Personnel WP/RC6/3 annex 1 Page 2 Personnel General Services I - Personnel Officer L - Personnel Records .il.ssistant I - General Services Officer I - Translator (English/French) L - Translator (English/Chinese) L - Clerk-Translator L - Procurement Clerk L - Supply Clerk L - Travel Clerk L - Registry Clerk L - Registrar L - Mail Clerk L - Librar;i.an L - Clerk-Typists (4) Uni ted Kingdom China Netherlands Switzerland China VACANr Philippires Philippines Philippines Philippines Philippines China Philippines Philippines CONSULTANTS EMeLOtED bURINQ THE fEAR Project Field Number University of the Philippines a. Public-health adm. 5 b. Parasitology ,c. Erwir. sanitation d. Bacteriology e. Epidemiology , Japanc Institute of Public Health Epidemiology 1 Poliomyelitis and rehab. of SBllle 1 crippled children _"China. Enviromnental ,,' ani tation Same 1 Trachoma Same 1 Malaza and Sin~aEorel Mental health Same 1 Sarawak: Malaria Salts 1 Inter-Country: Smallpox survey Same 1 Nursing seminar a. Educational psychd~ 3 , b. Adult .oducation c. Social anthropology Regional Office Nursing 1 Total - - 16 WP/RC6/3 Annex 2 Nationality USA USA USA USA U.K. U.K. Philippines U.K. Australia I US. ( . Australia ) USA ( , -' ( . TABLE I Project and regional office international· staff employed as at 30 June 1955 .. WP/RC6/3 Annex 3 C.ountry Hegiona,J. O:(fice Field • Total • , Australia: . 1 4 5 Austria 1 · 1 , Belgium • 2 2 • Bolivia · • 1 : 1 • .. Canada 1 8 , 9 · China 4 1 : 5 Cuba 1 : 1 Demnark · 1 1 , France : 4 4 Germany : 1 1 Greece , 1 • 1 · India 1 • 1 , Israel , 1 1 '" Netherlands : 1 · 4 5 · New Zealand 1 . 1 4 .; 5 , Norway 1 1 Philippines 2 3 5 Switzerland 1 , 1 , Uni ted Kingdom 7 10 17 Uni ted States 1 15 16 21 62 : . , ~ WP/RC6/3 Annex 3 'aBlE II The g~ographical distribution of international staff in the Regiori-a,l·Of'fice and on proj acts:, includi:lg ten ·consultants, who were transferred or terminated during the year, was as follows: .,-. j i . I I : · Country I Region~ Office Field Tota+ Australia . , 1- 1 2. Canada 3 3 Ch:ina 1 1 Denmark • 2 2 ., France • 1 1 • Greece 1 .L. Norway 1 I 1 Philippines 1 1 Spain 1 1 ~. ~ Switzerland 1 1 United Kingdom • 5 • 5 • · United States 2 12 14 - '4 29 33 wp/RC6/3 Annex 4 LIST OF SUPPIEMENTARY AGREEMENTS SIGNED WITH MEMBER COUNTRH.S DURmG THE PERIOD 1 JULY 1954 TO 30 JUNE 1955 COUN'mY CHJ:NA "CHINA CHINA CHINA FEDERATION OF MrUAYA FEDERATION OF MAIAYA FEDERJ~TION OF MAIAY.i\ FIJI FIJI HONGKONG JAPAN TITrE OF PROJECT Venereal~'disease control (Addendum 2) Maternal and child health (refresher training of private practising midwives) Diphtheria immunization Trachoma control Yaws control Maternal and child welfare sorvices Rural health training centre Yaws control Assistance to the Central Medical School Maternal and child health demonstration Assistance to the National Institute of Mental Health KOREA Midwifery training NETHERLANDS NEW GUINEA Malaria control NETHERIAII[)S NEW GUINEA Yaws control NCR TH BORNEO PHILIPPINES Maternal and child welfare services BCG mass vaccination * UNICEF supply pro gramme: WHO technical approval -lHf- UNICEF /KCAC programme: WHO technical approval WHO NUMBER China-l China-3 China-9*- China-13 Malaya-3 MALAYA-5*- Malaya-9 Fiji-l Fiji-2 Hongkong-4 Japan-4 Korea-9**- Netherlands New Guinea-2 Netherlands New Guinea-4 North Borneo-'7*" Philippine 5-17* WP /fj.c6/3; ,. i~ner: 4: ~ .. .;, Page 2 PHILIPPINES . PHILIPPINES PHILIPPINES VIET NAH WESTERN SAMOA - '. , .Drugs and diets supplement Environmental sanitation Leprosy control J.iaternal and child health demons tra. tion Yaws control * UNICEF supply programme: WiO technical approval ., :', '-'.} " ,", r . '. :' ... ~ . -, Philippines-26 * Philippines-43 , .......... Vietnam-3 Western Samoa-l HEAIXH ORGANIZATION AND SERVICES Public Health Administration DPH, f-iPH Public Health Administration Rural Heal th Sanitation Envi,ronmentalSanitation Food Control Nursirg General Nursing Medical Social Service Midwifery Teaching PH Nur sirg Psychiatric Nursing Maternal and Child Health Maternal & Child Healt h ....... --FELLOWSHIP AWARDS 1 July _1954 to 30 Jvne 1955 According to Fields of Stuqy am Countries of Origin I ! - - ~ ~~. ~ ~ i g ~ ~8 ~ 0 ~ 0 ~ E§ z ~ ::x:: N ~ ~ ~ ~ ::r:: .~-Cf) ~ ~ &l~ ,~ 8, -. .1 0 I:.) ::x:: 'J ::.::: zz z ! I 1 1 :2 1 1 I 9 4 1 1 1 1 1 1 :2 j 1. 1 1 , 1 :2 1 :2 1 -- ~.- ~ . @ .. :z: &1 t5 :z: H ~ /Xl S:: ::1 is ~ ~ ~ -p., Cf) :2 - - 1 ·1 -.' - .- ~ 0 .~ WP/RC6/3 ltnriex 5 ~- 0 ~- Cf) _ :z: - &1 .~ E-t z' &1 H p., tI) E-t -!!=- . --- 1 .- _ ... - ~ . - .- - -- - DPH, MPH - Courses for DPH, MPH :i>hysicians taking such courses without majoring in any sf,€cial subject. Those majoring in any SIB cial subject, i.e. VD, TB, MCH, are listed under that subject. Japan -. Of the two medical soc i al servic e fellowships, one was in p:;w chiatric social work. Mal.aya.- Of tte two DPH fellcwships, one was prematurely terminated. LaoS.. r.:.. TlE four FHA fellows hips are for undergraduate training. '\ WP/RC6/3 Annex 5 Page 2 Other Health Services Health Fducation He alth Sta tis ti cs Psychological Medicine Preventive Dent istry Drug Controi COMMUNICABLE DISEASE SERVICES Helminthology & Protozoology M€dical Entomology Virology Epidemiology Tropical Diseases Malaria VD and Treponematoses Tuberculosis Port Sanit ation & Quarantine- Biological Standardization ~ g ~ g:i 0 ~ CI) ~ u .- -- 1 , , -- - ~ 0 ~ ~ ~ ~ ;J ~ ~ j Ii! ~ E5 0 ;j ~ u :J:: 0-;, ~ 1 1 1 - I 1 1 1 1 1 1 1 2 1 2 1 1 ~ fa 0 0 CI) I ~ ~ ~ ~~ Q H I':iI CI) p:; H E5 ;::ll-f &i c:Q 8:: ~ z ~8 ~ &1 ::r: N :J:: H :J:: 8 ~ ~ ~. _. .8 ~~ ~ ~ t5 z fa ' .... H Po. __ ::s: zz z z (l., CI) CI) 8. 1 1 1 1 -I - - 1 ._ .~~ _0'". 1 i : 1 1 ..... _, , \ I , ;0 ,( CLINICAL, MEDICAL SCIENCES AND EDUCATION Clinical Medicine Thoracic Are esthesia Neuro-pqychiatry Le~al Medicine Medical Scim ces & Education Clinical Pathology Pharna ceutics Medical Education Zoology Applied Physio lcgy TRAVEL GRAN!' S TOTAL ~ ~ § E-! ~ CJ) ~ 1 1---1--- 1 2 3 3 ~, ~ 0 ~ :..::: :os r;f ~ S:! ~ ~ 0 0 !I: t-;) ~ f-. 1 1 1 7 34 4 13 ! 3 - Phllipp:ire s - Fellowship in Zoology was prElITR tur ely terminated. ~ ~ . 5 2 , fa sa ~ t'J)i£l1 ~ z ~z 1-1 ,,. !5 ~ ~ ffiH ~ >t 8 N ::c: ~ !I: E-t &-1~ ~ ~ ~ zz z z 2 I 1 , 2 1 ~ H ::.::: P-. ~ ~ ~ ~ CJ) 1 7 WP/RC6/3 .Annex 5 Page 3 r>:l e5 (l.. -"Xl ~ ~ z H Po. CJ) E-! 1 1 4 2 Grand Total - 87 ~ ~ t'J) Z &1 ~ ,.> , I I I - , I 1 '

iiORID HEALTH ORGhNIZATION REGION AI.. CONHITTEE Sixth Session Singapore 13-19 September 1955 j;genda item 10 REGIOHAL·OFFICE FOR THE '.rJESTERN PACIFIC }JP/RD6/3 Add. 1 7 September 1955 , ORIGINAL: :ENGLIaI FIFTH M~UAL REPORT OF THE REGIONAL DIRECTOR TO THE REGIONAL CONHITTEE FOR THE lrmSTERN PACIFIC P. d d e' n dum The following additions should be made to Annex 4: COUNTRY TITLE OF PROJECT WHO NUl'mER NORTH BORl'lEO Malaria control North Borneo 5 VTh'TIIDI C~ldren' s Hospital Vietnam 5

JJORLD HEil1TH o ffi.b.NIZ~i.TION REGIONM.. COMMITTEE Sixth Sesa. on .singapore 13-19 September 1955 agenda item 10 BEG IONiiL OFFICE FOR THE liESTERN P J .. CIFIC 1fP/ID6/3 Corr. 1 14 October 1955 ORIGINAL: ENGLIffi FIFTH JlNNU;J.. REPORT OF THE REGIONAL DIRECTOR TO THE REGION.AL COMHITTEE FOR THE WESTERN P i.CIFIC Cor rig end u m Page 30, end of line eight, amend to read: "2.013 million" Page 39, 14.1, first sentence of paragraph two, amend to read: "The objective of this project is to assist the Department of Health in the planning of new projects related to health and in the co-ordination of all the ~B:O-assisted projects in ope ra tion. "