WORLD HEALTH OOOANIZ.XION REGIONAL COHYITTEE
WP/RC4/2
6th August 1953 WESTERN PACIFIC REGION
Fourth Session Tokyo 3rd to 8~h September 1953
REPORT· OF THE REGIONAL DIRECTOR
INTROWCTIONa
·The period covered by this Third Report of the RegioDel Director to the Regionf\1 Committee ;Cor the· flestern Pacific has been a most eventful ana. Despite financial and other limitations not at all anticipated when the Regional Committee, in its last session, laid down certa~n policies and approved its programme and bud~et. considerable headw~y has, nevertheless~ been achieved. The suoeessf~l termination of some projects, the igUtotion of new ones and the redefinition of certain ethers took place during the period. In all these pheses of project development, government has been obtaiilfJd. The ccntihuati on o.f projects by local counterparts upon the withdrawal of the international personnel has been well. observed t~nd local preparations for the ~ni tiation of projects have, on thawhole, been satisfactory. When the need for modification of n project arose, in the light vf experience gain~d, joint consultations were called and redefinitions made accordingly. co-oper.~tion
The expansion of' the erea of this Region so ns tc include scattered islands in the South Pacific; the suocessful negotiations with the Roc}cefeller Foundat~on and the Johns Hopkins University in connection with a project fvr cssistenoe tc an educc.tional institution nnd the near attoinaent of' a full complement of technical personnel to meet increasing needs constitute some of the outstanding events of the period. Additional tec~nioal personnel hnve enabled us.to assist member countries in new P,hoses of public health work much needed in most ar~as within: · the Region. Thus, projects in he8,l th educ~tion have been initiated and projects in environmental sanitation hf.lve now gone beyond the planning st~ge. Co-ordination o.f work with . other agencies o·perating within the Region has been aoc~I!illishod through local oo-.ordi~a1;ion oomrni ttea s. Relations with other spec;i.a.lized sgenoies of the United Nations end bil~teral agencies opereting w1 thin the Region ·have been ·good •. c~used
Recruitment of personnel has been qulte difficu-lt and has delAys in starting projects, but the Governments concerned /have boen most
WP/RC4/2 Page 2 hev e been most underst nnding of this situation. Always receptive tD new trends in progrronme development in so fer os they oro a.ppliceble to the R~g-ion~ we hove endeavoured to incorpor11te much os f~st as·technicol support has boon modo available and opportunities for introducing them hove presented themselves. Thus, for example, emphasis in the attack on heolth problems common to severol countries within the Region h~s been shifted t:'rom n terri toriel tc· e. sub-regional basis. Within the ccnfines of c brief report it is not pcssil?'le to set out in full deteil the developments in every field~ ~nd if it seems that some ~ctivities ure stressed more than others, this is done for purposes of' illustration without any intent to detract in f!lny WAY frcm tho truly va.luoble work in other .. and perhaps less dramatic, fields. In this respect it could be seid that, in common vti th most hurfibn prot; res s, the-more spectacular results would not be possible without the solid foundation of' the l•3SS dramutioe MEMBE"RSHIP: M€liilbership of the viestern Pacific Regional Committee consists of' the following fourteen countries: (a) Countries with their seats of Government within the Region; 1. 2. 3.
4.
s.
Australia Cambodia China Japan Kcrer.
·a. 9.
6. 7.
Laos New Zee.land Philippines Viet-Nam
(b)
Countries responsible for· territories \vi thin tho Rrlgion:
1. 2. 3.
Franco The Netherlands Portugal
4. 5.
The United Kingdom The United States of America
The territories assigned to this Region are as follows: 1.
Gilbert and Ellice Islands 15. s. Guam 16. 6. Hong Kong 7. Macau 11. a. Malaya. lB. 9. N'.aUPU 19., 10. Netherlands New Guinea ·20. 11. New Caledonia New .Rehl"'idGs 21. 12/22.
2. 3. 4.
Brunei Cook Islands Fiji
13. 14.
North Borneo Pacific Islands Trust Terri tory Papua ond New Guinea merican Somua Sa.ra.wak Singepore Bri tiS.h. Solomon Islands Protectorate Portuguese Timor Tongs Other U.lt. ~me!
WP/BC4/2 Page 3
22. Other Uwl• and New Zealand possessions in the South Pacific 23. Western Samoa
THE REGIONAL OFFICE Generals On 1 September, the Regional Office will have. been at its permanent site in Manila for two years •.
Accomn1odetionc A lO-yeer lease for the building occupied by the Regional Office was signed on ~7 March 1953. This is subject to renewal upon expiration. Minpr alterations have been made tp help meet our requirements. With the near completion of our steff, the building hes become inndaqu~te; . arid :tt is now planned to erect one prefabricated building nearby to meet the situation. Organizet!onal Structure and Staffingc Re.pru:i. tment of staff' has been completed (please see appendices 1, 2, end 3). With the exception of one, ell internationally recruited staff have . reported for duty. Since my l,e·st report, the Regional Statistician and Programme Evaluator, th.e Regional J.dvisere on Helllth Education, M.aternal and Child Health. and Venereal D.iseoses, end the Budget and Finance Officer have as13umed their respective posts. There has been a very insi.g ,nif'icant turnover in ners,onnel. This can be t.aken as a sure sign that the Regional Office h,AS reached meturi ty and become more or less stabilized. The, Staff Committee is functioning smoothly and the personnel of United Nations Technical Assistance, UNESOO and UNICEF in Manila have been admitted as Associate Members. ACTIVITIES The highlights of the activities of the WPRO during the period under review are es followss Assistance to Governments in the Development and _Strengthening of Health Services and Esteolishment andl;Ia.intenance of Liaison and Collaboration Mony of the countries and territories in the Region were visited by the Regional Director and/or members cf the Regional Office starr. Several members of the Headquarters starr and speci~lly recruited short~term cvnsultonts on specific assignments also visited ports of t.his Region. Valuable information was exchanged and advice given. Members of the Secuetariat attended the .second South P.6i.£'4 Conference nnd the>fitth meeting of th~ South Pncific Commi&ai~n Research Council at the invitation of the Se~ret A ry-Generel of the South Pacific ·Commission. / The WHOjUNKRA Health
WP/RC4/2 Page 4 The WHO/UNKRP. Health Planning Mission successfully concluded its studies of the health needs in Koree and submitted its recommendAtions. These are to· be implemented by UNKRA with the advice and assistance of vVHO. During the year under review, we were able tc recruit to send a very well known hospital architect tc Cflmbodie, Hongkong, the Philippines, American Srunoo, Sarawak, and Viet-Nam to advise on their plons tc rehabilitate old hospitals or tc build new ones. The plans for the 250..:bed children 1 s hospi tel in S igon are in their final fonn. It is expected that construction will seen begin. F-~nd
The \fflO public health edministration expert assigned to Viet-Nam wns appointed, With the col'lcurrence of WPRO and the Government, as UNICEF represent~::tive to c,.unbodie, Laos and Viet-Nam. Due to his resignation, e replucement is being sought. The VfHO public health administration expert for Cambodia will shortly assume his post. The UNICEF Mission in China (Taiwan) has withdrewn. Bec~use the need for such an office is great, negotiations are in progress with the Chinese Government to establish a WHO/UNICEF Liei'son Office. Co-ordination c.cmmittees ccntinue to function effectively in several countries. These hnve contributed much toward the prevention of overl-epping ond duplication o.f internc.tional efforts in the he!'llth field. The need fer co-ordin.Jtion as early. os the ph.nning st,vr,e cf projects involved has been emphasized, and adherence tc this in scme countries is producing good results.· Educllti6n and Training The post of Regional Adviser on Educetion and Training will soon be filled by a highly qualified md experienced specialist. In line with the recommendation o.r the RegionAl Committee at its third session to provide for more intraregional seminars. during 1953, a nursing educP..tion seminar was held in Taipei, e vital and health st~:~tistics seminar· in Tokyo, and a pan•pacif'i c tuberculosis conferenc.e in Manila. The r.eports and comments en these were most favorable, indicating their great success and usefulness. Detailed reports on these meetings will be f'ound elsewhere in this publication. A mental health seminar will take place in Sydney during August in collaboration with the Australian Government. The help of very highly quolified personnel h£',S been enlisted to organize and cvnduct this seminar. Excellent candidates have bean r.ecomm61nded by governments fc·r fellowships provided by WHO to enable them to· send pArticipants. / An inter-regionc.l malaria
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An inter-regional mclariF) pontrol confer.ence organized by this Office flnd the Regional Oh.. ice . for Southeast 'Asia will be held in Bangkok duririr; Sc?tember. This will be in f.lddition to the rur~.l mAlari n. c• ,nference scheduled to be held in Taiwan in 1954. In ~mother pert of this :repcrt is mentioned the WHO ossistence beinr~ given to the University of M:-.;l~ya and the University of the Philippines. Eighty-thrse (83) indi vidunl fellowships, tot~ ling ~71 fellowship-months, wore awarded during the period under discussion. For det~.ils, refer to Appendix 4. Nntion~ll fellowship selection ccnnnittees have beeri most.ao-operative, end,.t.:~s e result, officers in chflrge of institutiqns and deans of sohools · of public health nt which )VHO fellows hove studied hflVe commented fworably on their calibre and tho level of their achievements. Tho Hogional Office hes alsc, boen of assistmoe t;: other RElgions in the placement of their fel:1ows in institutions or org;,nizaticns in countri.es of t-he Western Pacific.
WHo hns been re ..~.uested t : ~;~ssist certAin governments in this Region in the .fotrnulotion of requests and in the selection of Cf;ndidates for fellowships made avoii(lble by Ccnodn under t .he Colombo I>lan. I would like to take this oppc,rtunity t~ thonk the Governments of the Member Countries, end the institutions in theso countries to whiQh wo · hnve sent l"ellows, .1..or the c o-operation nfforded this. Of'fico ond the hospitnblo reception end generous r.ssistance given tc fellowship holders. ·
.Promotion of MeternAl end Child Health The volue o f MCH domonstra.tion centres he~s bet~n illustrflted by three i"iHO-nssisted projects now being implemented. Mt'lternul o.nd child he~:~lth is no longer c oncerned only with survi vol or de nth, but with quell ty of health. Emphasis is placed on this concept in the demonstrntion centres. It is new c.::>nsidered the-t one of the periods nt which m)st supervision and nssistf1nce is needed is the pre-schocl .age •. In the past, insufficient study has been m.ede of this group by MCH 1 workers. The pre-school ago group is now being giv~n the supervision th:e.t is so importont to the future total development of the child, physic 1lly, mentally £·nd socielly. Maternal end child health vmrk consists lergely o£ teaching, end education is recognized ns boing E slow process. One conn•Jt hoPEr to bring about to"t!'ll nnd dramatic chnnges in moternd and child he~lth in~ matter of n few-ye~rs.
•
Nursing and Nursing .EducP.tion wr.~s
The Nursing Educaition Semin,-.r thst
held in China (Taiwan)
/in November 1952
W1J/RC4/2 Pege 6 in November 1952. w·1s at ·.ended by 29 pr.rticipHnts from 12 countries and t.arritories in the Region. This Seminer prcvided the opportunity for nurses·- in the Reg,ion to meet, share mutual problems, exchn.nge ideE-s, f:llld work together toward a common goPl. The benefits of·this study conference ere fnr-reechin~. Pr.rticipants heve reported tb!lt the St>rninrr l-lrs helped them to improve their nursing school curricula, to f:,dopt more eff'ecti ve methods of toaohing, to rnnke. better use of visuel c.ids, and to deYelop understonding of inter-person:'1 relntitmships. Upon their· return,. the ncrticip,:nts from the Philippines conducted n workshop in Mtmiln that. Wf.'S .. tbm.~ed by more th8n 50 nurses from oll pnrts of the country. Participants from ChinA (Taiwon), J8pDn, end the Territo~ of ?npuo nnd New GuineA Are discussing plons for locfll study r;roups. The Seminor is considered the beginning of' e. longterm educational plnn to ~1ssist the d~vel.opmEl 1t of nursing nnd nursing education in the Region. The·conducting of seminars is one significant way in which WHO con give ~e:::.dership in this field. The next seminar will include nursing school administrators, hospital nurl:liUf; directors r.nrl supervisors, ns well es nursing instructors. It is recognized thot,. i£' progress is to be mode in nursing education, it is imperl;'tive that nll personnel. concerned \Vi th nursing educetion end service have common gocl s and "'·n undor.stonding of one another's problems. It was agreed F•.t the Seminar that "one of .the mdn gof:ls of nursing educetion in !ny eoun1:ry should be tc prep;.re nurse leaders to assume respcns:lbili ty f'or oducoting nurses to meet the needs of their '·~'i1l country. When such lec.tler$hip is prosently being giv0n ty nurses from other·ccuntries, this goal should be kept con~?tr.ntly in mind .. even though thf> position of women, erluc""tionel opportunities .. economic r'nd social ccndi tions ere at thr:: moment on t~ level well below the possibility of' attdninc; this objective in the f'oreseecble future." Intern·,t ionol ossfstrnce ccntributss toward th•J attainment 'or this ~onl when the best ~vcilnble loc~l nurses oro t:!Ssigned by the Goverrunent t..-:1 work elcng with nurse eduo~to:rs, so that local nurses gc.in experience vcccrding to their <:>Oilitif;s in grA·iual preparation for cssurning full resnonsibili ty for nursing, londershiy. It was emi?hosized r;t the Seminar that 11 thc: method of' nursing educ~1tion thot depends upon student nurses t c ·render ~.11 or n lr.rf!;e pnrt of the ess.;nti!:l nursing servicf; in tl hospital is recognized ~·S detrirnentol to the t:: dequote education of' tho nurse fer future usefulness nncl tr .the ultimate impro-..rernent of nursing services." There is a tendency in some countries to buil.d ~1ospitals _e:md hoalth centres before trainin;:t pi'ogr~'~rmnes "'re instituted to provide essential nursing personnel tu str,ff them.
in operation in Cambodia, Chine ( To:i.wran) ,Mf.llcya, n.nd N~rth Borneo, /nnd hmre been requostod
Projects to strengthen bf,c;ic scho ·ls of
nursing~
.re
WP/RC4/2 Poge 7
and . h~av~ been requsste~ by Hongkoog· end Singnpore.· Improvement of the trdning of public · hur·lth nurses, Pither ns, port of MCH projects or n\,\rsing~ educ_~;~tiori projects nssisted by W HO, is being carried out in C~bodin, Chine ( TF.l.iwon), Hongkong, Mo.lcyr.., ond North Borne o and }:!.Avo' been 'requested by Singapore r.nd Viot-N f'.m • . A project to assist in the treining o~' nurse-tenchers hns been requested by Jepan. Th~ project for,the training of assistant nurses in Brun~i will be completed this yoer. Health _ E ducotion of the Public Heel th workers t:md other groups interested ·in the-i ilnprovement1 o(' the heAlth of the people ere f'u :,ed with tho diff'icu~ t problem of stimulnting people to change their health ~ttitudes end hobits and to participate more effectively in improving the health of ·their neighbourhoods end communities. In order to eccompliah this, these workers must hove cert~in b 0sic insights into h~al motivation and skills in developing desirable working relntionships with people • . In short, nll heel'th workers need to understand and be ~ble to utilize educetionel processes. During recQnt years, there heve been ropid advance~ in the science and technique of education • . These advances hove progressed toa. .point where mony'" o :' the teaching mE!thods used tod Ry are oonsi0A ~e d antiquated• It is impbzi£lnt, therefore, tht't opportunitiee.- pe provided throughout the Regio.n for the exchtmge of ' info:nnetion about t~se- ·• nErW methods. In-sorvice educntionol oppo·rtunities need.. to b:e prov.i ded. The Regional Office is working along these lines end for the pest ye ar . hes h(!d on its stnff on ~dviser on..henlth education of the public. He h c s· vi~ited various countri.es tO assist in studying their he~l thoouc nti.on needs n nd problems. In ono instance, he assisted fl country 'in the formul,-,tion of ·a iong.;.rnnge health education programme. Whero . governments nre interested, projects cen be developed to emphnsize ond demonstrnte sound procedures on<l practices in he:elth education ot the pu.blic. This CAn be done in meny w~ys, ..,ut a perticull'ir · exomple is th -:i t of the work of the WHO health eduel'ltor attached to the Depe:rtment of Soci~;~l Hoclicine end Public Health in the University of Malnye for the past yoor. As well es ca~ying out her teaching duties at tho University, she mcde herself avnil~ble to the adult educ ation - tnd wali'ore groups, the Education and He~th Depa.rtroents, the Teachers Colloge, etc., both in Singapore end the Federation, thus demonstr~ting the multi-purpose usefulness o£ the health educator as well as facilitating the development of health educetion concepts in verious official nnd volunt~ry health orgenizations and rel nted groups. A proje ct of' simibr nature , but centered in the Depf1rtment of ~f.edic nl Se rvices in Sarnwak, wos tennin~t od this y e f!r, v.ft e r l e ss the m four months, n.t the Gave rnment 1 q ~€> one st. It is fel-t thot hail. ":h c1uc (ltion of the public is en integrd part of al.l health end medic ~ l progrmnmes nnd thA t the educationt>.l approach sho ,d d be stimulated on d encour2ged whenever pos-sibl e .
Country-wide ond re gionol
WP/RC4/2 P~ge 8 Country-wide and regio!l!'l he~lth education conferences have been requested by various countries end territories. It is hoped tht1t o regionAl conference in health education crm be held in 1955. Conferences oJ' this nr..ture bring toGether -o;bo vArious lenders nnd workers iri each ·'country who. erE; direc.t ly concerned with health . educotion 0 t~ the public' for the pur.po'se of exch~nging information. studying improved methods nnd techniques in hef11 th educption and shnring idens concerninG common problems. Through the fellowship programme, key hefllth educ ~Jtion posts cnn be strengthened, stimulf.lted t.nl'.l encournged by study. ond observation abroad. It is also hQped that A regional training centro for heHlth educators c~n be established in the not too distnnt future. Environmental Sanitation Eb.vi rqnm~~t ol . Sanitation hcs long been recognized by pu blio health workers ts ' 'a vitnl element in control of a large and , import~:mt group of diseases char.,cterised not only by their diseblint; ability but slso by their debilitating· effects. The enteric disorders and helminthic iufestntions produce, '111 edditlon to epidemic phenomena, en enormous ground swell cf' sub-clinical •::r;ses '\'\hich cumulatively can Si!p· the onergy ond productiVity of a1l. nrGO. Where. environrnentul sanitation has been neglected. An increased omph•Jsis and renewed interest on the part o1' officiels res-ponsible for public heo.lth in countries of' the region has been noted. This in tore st hrs been l"eflected by an incrc:ase in requests from countries within the region for cssistnnce in strengthenin~ environmentd sanitation services ~:~nd fPcilities.
The Regiond Ad•Jiser on Environmentol Sr> l1i tntion has been active in studying regional end country problems in his field. He hf's visited some of the C(Juntri·~s within the region f.nd assisted them in surveying, defining end evaluating their probl~ms in sani t0tion. In one country he is engi:wed in the pr,jp,wntion of n long-r!'lnge progrmnm~l. Endento-Epidemic Diseases m~ny
Malaria .still rA'1.ks t: s o major public heol th problem in countries of the Region.
During the period under review, the VVHO-ossisted mda.rio. and insect contro-l pro-jf~ ct in China (Tniwan)· end the melario pilot projects in the Philippines and Sarowak hAve pro·gressE'Jd satisfactorily. The foundntion is being lrdd for the eventual er8dicotion of maL\ria. from TaiwAn. In tho Philippines, the proliminory results of the pilot project have been utilized by the Government in their planning of en extensive mnlar:if>. c,:,ntrol oartlpf:'ign, while in Sarv.wek, the first round of DDT ond BHC rosidun.l spraying has been completed~ Due to budgetary L ..--.: t t~tin., ~. VJHO assistance to the m!=ilaria o.nd insect cont1 v.1. project in Ctunbodit" was suspt.=nded from 31 March to 31 July. 'Thj;; ;,::;;:n.stence, howt1ver, hr• s now b€en
resumed. / Uoon thG request
WP/RC4/2 Pc ge 9
Upon the r0quost oi' the Governmant of Viet-Nom, Wl!O f,.ssistl)nce to the mnlo.ri ~ nnd insoct control project in thrt country wes withdrawn on 30 June. WHO assistance tc n mnL·rio pilot project is now urider negotintion with the Govennment of North Borneo.
Upon requGst or the governments, fellowships in the field of mcl 1~. ri>': control h ove :~een cwnrded in an effort to tr~in os mo.ny locnl personnel as possibl7• The Regionc.l Office is collr'borrting with thot for SoutheE~st Asin in orgonizing n molnric: control conference which will be hold in Br'.ngkok, 21 to· 24 September 1953. Another mnl~1ri c ccnfert>noe is scheduled to be hold in T::ciwon during th~ spring of' 1954, under WHO euspices, This conference, which will be confined to technier.r discussion of rurol melaria control, is supplementary and complementary to the 1953 malaria control conference, mentioned above. It is believed· thot thes.;; two malaria conferences will serve a very useful purpose in. a.osistinc l-IL.~mber Countries in the development of co~ordinated ~nd integrated malaria cGntrol pl cnning and operations on an inter-country or sub-regionol plnne • .An importtJnt trsnd has shewn itself during the year regarding anti-tuberculosis work, tmd this trend WPS fully discussed at the PanPacific Tuberculosis Conference held in Mnnila in April. The Organization's direct ossistonce to governments in the BC(t: prog'renmi.es is lr.rgely completed, and the tendency now is tc integrate th'G .BCG work into cornprehensive . prograrnrnes of tuberculosis control, · ~.e. to make the BCG wcrk G port of the pro;::rcmme to centrol, or prevent, · tuberculosis 1. c11 ~o3~i-1::lo no.::ns. Furthe:r.n.:ra, such ., tuberculosiS control pru ;~ r '· ·l.:" sh:;ul ', be ~ pr.rt of thi_, ()Vcrr;ll publ~c heslth pr8gr~mrne. Ou:: ~· in is t·: encvurr,:~e, and assist, such uni.!:'i ed ·:~,lens. O...tring thE:< year, BCG cempeigns started by governments with international assistance have tp.ken pb.ce in Brunei, China ( T~twan), Hongkon~, the Federnti on of Mr.loyo, the Philippines,· Sarowcl<: and Singapora. ·~1e cronpeigns planned for C~wbodi~ ~d Vi~t-Nem were unf'ortunately delayed O'Ning to recruitment 'lif'ficulties, but ere expected to stf\rt very soon. As regnrds BCG production lebor:.< tnries, the unit in Alnb.•mg, nenr Monile, hr-s produced I'll the vaccine necessory fo !. tho Phili-ppines cempoign end hcs exported tc Brunei, Chino (Taiwan)~ Hongkong', Indon.esia and Sarawek. The large units in Japan wore v'isited, in April, by the Chief of the Tubarculosis Sot}tion 5.t a~,~dquarters, Geneva. The unit in Sa igon will produce the vnccine for the cemp~ign in · Cambodia and Viet-Nem. Tho unit in Taipei, which received the ofi'ici~l approval· of the Org!'lni ~~+i ,.,.,., in Me.,.." h ... is, new producing the vncoine for the campnign in Toiwen. ·vve hr.ve hnd no <iire~ot contuct during the year with the unit in" Melbourne•
On behelf of
WP/RC4/2 Pr.11;e 10
On behalf of the Orr.:· nization~ an int ernational expert on BCG production visited the units in /!!"bang, Kyose (Japan), Saigon, Sendei (Japan). and Taipei in February ~nd March. Wo believe th:~t such ·visits ore Vfllueble in meintaining intem~:~ tional standc,rd~ o.nd in keepiP-g the specinlists in touch with ell the lBtest discoveries in this fiold. The ·. P.nn-P~cific Tuberculosis Conference, sponsor,.3d jointly by the Philippinns Ci ; ~:<-)r!lment, · the , Philippi n Gs Tu~ercul o s is Society and the ~·lorld lit'H:1 lth Organizetion, took plr.ce in M&nila in April ~nd was nt'tended by dele ~;~tes fr<lm 29 countries E:.rtd by numerous observ6rs .. Four .g:uest speakers presented special ptpers, eooh of the four presentations belng followed by A discussion. The moin o;bjec:l; of the .conJ.'erence wr.:: ~: t o 'get. tcgothe r tho senior o1'fic~.~h c::1ncerned with. control, ·or· prevention, of tuberculosis in the vnricus countri<:~s, and to present to them the views of the guest spe.:ke ,~s and the results of the Organizati on' B studies in tuberculosis control. Emphasis was pl oced on the pub lic health ospect or t~e problems . i.e. on prevention r nther than cure . Tho Vfllue of the conference 1 ey in the v e ry full discussion on tuberculosis Ci; introl·which followe d, the a.greem6nt to .use unifonn methods for ccntrolling the disense in the P r~n-Pr: cifioJ areo ond tho eleven resolutions which were crrriod unanimously. The exchnnge of inrorm~ti.;,n hetween delegates, Qnd the aE;reemont to use unifonn .rr'3thods, not only ensure s .th(;lt the most modern appro nch will· be adopted. but also that . comp t1 r r.ble results will be attained in oll the countrios using the stc.nd2.rd method. This will m•lke .. it possible t c) compe r e and. eve.luc.te tubsrculo sis controi programme~ in .fut.ure years to a much greate r extent than has been possible in t~e p st. More,over, it is hoped to repe nt the C·;n.ference once evQry .f~w ye :?tra, tc . compr< re r e sults ~nd to bring the standa rd .method up t c :lete os scientific .knowled[:; u edvf.mces. The conference h a s been, reporte d in speci Jlist journ;1ls all over the worl.d. The ~rocaedings Are now b eing pNpn red find r• copy will be sent to ell the p9rticipAting gove r.nmen t s. The post of Regionol Venere >J l· Dise cses .. '> dviser h r. s been filled by 1:1 qu~lified nnd . experienced spoci nlist. Since jo,ining ·the st ::ff, this adviser hils visited severPl countrie s end territori'es in the 'Region • . · In addition to the · UNICEF'-assistod treponematcses cont r ol pro~ r~~ in the Philippine s to which WHO gives technical ~~ dvioe and supervision,. the r e are V.D. end treponem) tose s proje ct s hi Chin<:- (Tni:van) and Li1o s, assisted by WHO. . The WHO/tJNI CEF-assisted. yaws o emp a ign which ~as implemonted in conjunction with the BCG project in Sarawak is being continued by tf> n ··'. - , .Jrnmont. · Constt~t ~:~ti cns oro in:progress for n WHO/UlUCBF... ,. s s i sted Y P-WS C!'ll'ilo~ ign i n M a.l 1:1 ya. In the prcposed progrrumme ~nd budget est i~tes f or 1955, you will notice thnt provision h ns been. made for · vmc.\ :::~ ssistonce in thi s
/field to sev~rsl
VI/P/RC4/2
Page 11 field to several other territories of the Region, in response to government requests received • .i1 short-term trachom~, ccnsultcnt visited several countries of the Region to ~ssist governm~nts ia their 8ssessment cf the problem. Informntion wns exchf.lnged with local speciolists, lectures were given ond operations performed. The opportunity w~s tnken to introduce the metho.ds Adopted· by the ymo &xpcrt committee for the classificf'tion nnd treAtment of trechomo. In certain countries of the Reg~on the incidence of trnchomo. is very high, pnrticulrrly emon~:S children. Often much scarring results. In one ccuntry it was estimatro:d thct eb·JUt 60% ot~ blindness WflS due to trechomfl • . The "NHO consultant assisted in the initiation of Q.trachomo trentme.nt pilot project in Tniwon, using UNICEF supplies. ·~he results hcve been so gt;cd thct the Government has decided t1) embark on e three-yenr project to coverall school children 1nd their contacts on the islnnd.
Assistance under the Expanded Programme of Tochnicr1l Assistance for Economic DEH'olopment Towards the <md o.f' 1952, WHO was noti.fied that its shore of Technic'-11 Assistnnce funds h!ld to be dro.stically re9,uced. ..~s a result, £\SSistnnce fGr s.;,me 1?roje.cts to be initiD.ted in 1953 was Cfotl.celled; in certain cases, assistance to projects already initiated onJ to be ccntinued into 1953 nhd to be reduced. Fortunately, UNICEF promptly nnd generously cnme to our assistance by providing funds to pny for some of the internotionol staff and suppli~s in. H}53. In 1954 and 1956 every ottempt will have to be me de to ccntinue the required ossistence to projects Cilr.cady implemented. Pro,j<Jcts to be inithted in 1954 !'lnd 1955 ~:re listed fiCcording to a suggested order of priority o.nd will be ossisted in thrt crd(Jr ond 0nly to the extent thr..t funds ore avdlnble. In thG pflnt, it hod been the ~sual .prectice to r.equire governments to provide lodging nnd to furnish the locnl currency to poy for thEl intarnotionol experts' trwel n.nd subsistence requirements \vhile on local officinl trovel awny from their duty stntions •. Only in :coscs of extreme hnrdship were governments exempted from these requirements. For 1954 ond there~fter, governments have e~ch been a~ked tc p~y into the Technical Assistance account a fixed sum in locnl.currency which is estimAted to be the govE:rnment' s sharf3 towards intern9.tionsl personnel's loccr living costs. This amount is to be edjuste<l nt the end of eoch yeAr. Since the !:!Ssisted projects Are actuE1lly integrPl pP rts o.f the gov'ernments' health progrcr.tmes or are s oo:n to be so integrated. end these projects are to be continued. after the withdrawl'l of' international oid~ the governments are expected to meet the locol costs for buildings, local sal!:<ries, supplies, etc. DAiTA 1 ~~~,...,1'\t;
-··
or .Ir· "·'lrn1.6d Opinion and Active Co-oper 1.\tion c~ tht:' .Pal; of tht~ Public
During the pest yea:r the .~taft' of the public information unit came,. for the .. first time, up to ,full strength• In spite of this,
/however, the pressure
WP/RC4/2
Page 12 however~ ·
the pr e ssuro of' work he>s remained 1)eyond the resov.rces evailAMe. . Finmcial limit~ tiona have caused the shortage of essentiel·mnterio.ls to be maintained, while the high coat of photo reproduction, printjnp,, postac;e, etc., has prevented the implementation of' £; number of plans.
Incref1Sed interest ln ~'iHO has led to .s n extended mailing list of over 1500 individual addresses, and u greCJ.t, and ov-ertr.rowing, number of' rGq1io.:lts for muterials illustrpting world heel th work. Iy is honed to obtoin wider e ssistancb f'rom governmtmts in th<~ transletioJ?-, reproduction and distribution of :i.nforin....,tion moteriBls. Such assistrmce would ue invalueble in helping to close the existing; gap. Durin;<; the distributed. Over 4,000 copies of' the WHO Chronicle in Chinese were distributed during this period.. Tr~nsletion wes completed U!J to the .Aut:ust issue of· 1952. Twenty-six press rele&ses and 12 press notes were issued on vmo ncti vitios. The serd es of rn :li::> broadcasts which was commcm,.r,d in the e(1rly pf.lrt of 1952 was continuedJ recording.s: W{'lre mE~de in the field; recordings received f'rom Genev" deeling with the Assenbly :md the Executive Board were broadcest. A nU!'Jlber of phot c srl'lphs of VRrie d regionP. l activiti e s were taken. Exhibits portraying the work of' the Org!:lnizetion wcre shown in Maloye, the Philippines, . 8:-~ir,:on, end Singn rJore, ond will be further displayed later in the yeP.r in ether pl~ces. p~1riod
under re,vhnv, over 36,000 units
o£' inf'ormstion moteriel, of' 15 types in 4 lnnguagos, were
Sever,:ll WHO publieotions were transleted into Chinese. Translation into other languoges of the Region is bei!lf; explored. , large nu.'tlbe r of visitors to the Office were provided with inf'onuotion ond information materi .'-'1• World Health Day was observed in most countries t1nd territories of' the Region on .~pril 7th. The r.1rrnngements mnde coverc:.rl the production of' posters, folders, booklets md prnnphlnts1 press interviews, r<1dio talks flnd public meetings; cinema shows; school lectures,etc. It is very encouraging to note thnt in many countries of th(i Region, th0 observance of 1~orld Health Dtcy" has become more extensive. For oxrumplG, in Koren. in spite of sreet difficulties, YlorL!. HeAlth Day..,.. ., ,..·. rkod. ")y o nation~ d a vur1 .• e·t J or " ac t 1v1 ' . t. ~1:·,,·; ;:.·' ::v.;x·vrno.: ;, ;: :.Lnn · !. r~.::..~.,.w.t~ l.es. s i.n the previous year, Brx'Ci81 pcsten . ("t?nsed ()in the cover of' the "Health is Uealth" bvoklet) Wt3re produced ~··1 cl ettrAotive, reprints • 1 • • • ; ,. • , '
/in Korean wer~
WP/RC4/2 Poge 13 in Korenn wura m~de of the w~o Facts nnd Fisures and ~orld Health Day meterials. In Singepore, a particuh1rly comprei:el:uiive ,exhibition was Arranged r.md brotldCflsts and addresses were given, 1'Vhile ·in Hon1~konF,;, in oddition to o pul,lic meeting held with the activo (v) ~o;;:.:-t!"ation o'f: the United Nations i1,ssociation of Hongkong, W~rld HeAlth Day materials were ·accorded wide publicity.
ACTIVITIES BY COUNTRIES
BRUNEI Nursing Education A troining programme for r,ssistant nurse~ estoblished in Brunei, with the as•~istf;. nce of f.l. WHO This progrrmme hctf mf:.~d.e significa.r1t socitl history. plrmned two yev.rs ·•1go, · soci :1 custom did not permit Brunei to l i v·e fJ."rTBY from home. Very .f ew t~irls Went has bElen nurse instructor. i'jhen it Wf'S first M(:le.y girls in to school.
With the understendirig enJ . influence of' Government officials, the nr:BO nurse te ;:;chGr persuaded a r~roup of yrJunf, ''romeri tc: enroll in the ~~ourse f'nd to live in " :r.wdest but comfortf,blt: dorrli tory under supervision. Thi~ dem·:.:nstrl'lti'Jn prcjeot he:s proved thet carefully selected girls, thow;h they mP.y need to be tDught such elementcry procedures ~)s remi'i.ri:; H wntch, cnn bocome rd ... ponsible 6nd efficient f!Ssistent nurses · er'ter 1'5 months of well-directed trr1ining ·in which emphnsis is pl ~ ~1Gd upon indbidunl student P.bilities and needs. Tho co-operation of' tho hospitd ndministr<Jtion in making possible c trnining progrem.me based upon the r·~·quircment for f:tudents to lonrn gr:>od nursing care, rather thim upon the immediflte need :for hospit ·:l service, 'hns obtdnod for the hospit::. l r-, steff of wel1trdned ,;;oung women whc nre providin}; ess0ntiol services to the best of their individud flbilities. r,:other:; of young women v1e ro encour;Jged tc visit th(: hospit~l .r1nd health centre s t o ·m;tch thE< studf3nts leBrn· tc csre for p~tients. Interest began to sprend And new recruits were ·enrolled frcnl outlying districts. Tne Bstlist"'-nt nu·rses ere highly respected in thE:l corr.r.1unity. More people are tuking ~dventage of heolth services.
More advanced training is being given to A small group of students who will become the nucleus of the 1'irst qualified nurse tro.inins progrorrme in Brunei. MrlE:rir- Control Assistance is being provided by thG pl"'oject lee:der of the 'JiTHO-essisted malr:>rie pilot project in Sor~vrok in the fc~t'n cf technical ~1 dvioe for and ganerF'l supervision of the nu=1le.rio control !\Ctfvi tios in this territcry, us tm e:x tension C.f the project .in Se.rewAk. BCG :SC(r wvrk wils str;rted by the Govornmei:i't with i'nterrietionel
/f:\ssistonco lt:1te in
WP/RC4/2 Pnge 1-1· assistance lat• in 1952 an . ·} continued into 1953. 1.1ay the tot Ells were t Sturting test Completing test ne!l:etivo Vaccinated At the end of
29,483 24,130 8,563 8,552
As the total population of Brunei is just over 40,000,it can be seen thAt ~ large proportion of the population has ~lreedy been reached.
CAMBODIA Public Health Adrninis.tretion A WHO p\tblic heol th edministrr,ticn expert hrs been recrui te;d. Upon request, he will essist the G~vernnrent in making surveys ond plans., and will (ICt ~s WHO lidson officer with the other United Netions org'lnizt.;tions 1 .\lld multihterel r;nd bilaterol nP.;encios, as well as co-orc!invte tht~ ectivities of all \ffiO-assi sted ?rojects in the country.
Ecole des O£'ficiers de Sante The ¥rHO meternel end child hGalth expert has continued to tec.ch et the Eo.o le des Off'ioiers de Sante; senior students of the Eccle go to thF.t poedi atric ward f!.nd the health centre for pr£lct{cal experience. l':edicel literHture, up to c. totol cost of $2,000 is being provided. In July, another iffiO BXpert commenced lecturing at the Ecole in m-:~tarncl find child heolth; She is dso (lSsisting the Government in its school hel'llth progrvm.";lG as well f\S in maternal nnd child health -.vork. s soon ns further i'acilitic:~s in this school permit, othe r pers·:mnel will be added.
MCH The '\iffiO-assisted. mE:tsrnGl .~n d child health project hes been in operation since Februory 1952,· ond n Government request for its ccntinu~.Ction through 1954 and 1955 he-s been received. With the nssistance of the public health nurse frcro the iiffiO nursing educvtion teom, the MCH dem(mstr2tion centre ho.s estnblished r.: gcod J?rogramme P..nd is providing a complete service tc a smell ccmmunity in•the neighbourhood of the centre in Phnom-Penh. In order th~t the t8f!Ching may be spread to other r~rR9S, it is essential thct the dovernme'nt f.1 Ssign . their ov:n steff to work as opposite numbers in the Centre for ~1 long enough period fer th&m to be able to establish aimiler pror:ra!Tiil'leS in the centres to · vhieh they will be sent. With the helr; o l the 'dB:O paedietrlc nurse, the MC!! doctor h~s established e much inproved pnodiotric unit cr 25 beds in the genernl hospitnl in Phnom-Penh.
The function o ::' the project, which is to t:omcnstrpte cb'D.d Oo"Ni to local p•~l'"scnnel, hos been made diffi.cU:lt owing /to tho f'requen't
-~;p /?.C4/2 Pr· i~Et
15
to the frequent chnnge of nationel c cunterparts, portly nocessit :Jted by militory ;r2quirements• . It is hoped thot tho number of' local personnel "fil~ be1, inC:rC(JSOd shortly · to enablt.!J further progress to be made with the: pr·ogrt:Jr:une, invol vint; extension N ... tlH..l work to oreas beyond tho city of,. Phnom-Ponh. One fellywship holder h~s oom-plet•?~ his tprrn ~nd "' second is to prccHed to Europe in Dec-ember t0 study sc-cid p~edietrics. ~g
E<1uc11tion
Plans . for. the now scho > ;l of nur sinr: :;.t Phnom-Penh cc·ntinue to prccress •. The best eV!5lilabl6 nurses h"VB be.;n r.~ signec ~s locd counter.parts by the Go,rernment t o stu.:iy on:! work with the WHO nurse instructors from the beginning of' the ~'.re ject.. 'I'hr}y nre trking on inorer.sinr; ~JT\r. unt of rt:.spc:nsibili ty in the pro:;romrne. In-servj.cE! refresher ccursos for nurses; ond te"'ching and demcnstrati op in the p r:ediutrics w;_, r ,:.] ' tln:! h'1f lth centre hr-ve continued. 1': is r<::!;liz0d that th.B u ro\\·ision >.ri' locr'l nursinf: lec.C.ernhip in Cmnbodin will ..require co.n siderobfe. tim·e~ ... F'urther de v'3lopment of the pro ~ rf.II!L""'e hr.S been handicapped b~' d(\loy in r e cruitment ~1' •Hidi ticnal WHO personn<1l to bring ,the toAo t c full atrtml!,t r,.•
Mal a ria Control Tht;J ,meL ria and insQct c ontrol t(:J,,m CE1rried out limited operati ons because of loc ~1 security c ci ndi tions. WHO assistnn:ce wc>s suspended from 31 hsrch t o 31 July 1953 c, n account of budg et~ry l:imi. t .1 .tions. This will soon be resur.1e d vd th the f1S sigr.ment .of a ma.lariolofist who is now undergoing trrd.ning m d a scnib'r.i:>.n.. who hod previously be e n n ssigned t c Viet-Nom. BCG
UNICEF supplies · were reody ~ d Government ·p.rrnnr:emon·ts complete on the torv,et dote, 1 October 1952. Un£'o rtunntoiy,· the' 'BCG project had to bo delayed owini; tG the difficulty of' f'indine; : suit f:' ble internationo.l personnel. It is expectE:d th~ t the project will . start very so on. It is expected thot o sui tl'l~le t e mn lender will shortly be ev!'liloble, end orran<;;oments fc;r prel:i.rnin::n7 tr!1inint; ore being mode. CHINA (TAIWAN)
MCH The VIHO,/uNICEF-e.ssisted MCJI demcnstrfltii)n proje~t in T!=lichung has completed its first yec.r c,f' .a per. --tion• It wns vri th r e,;, r G t thn t the rosiiw,:tion d' th~ MCH expert, Dr. Sc :,vill,e, wns roceivEid f'f'ter one y w -.r ~).r 's ervice. H!ir wide .. interest
/in ev e ry r.:spe ct
WP/RC4/2 Page 16 in every nspect of' public health work, including he r.<l th education, was widely fl)Jpr<Jcir;ted in the comri1.unity. She hns not yet been replAcEJd, but i t is expect(d thet o suitnbl•3 repl£1Cement will be found shortly. Arrangements for the further trnining riumbers of' the internr.tionP.l ... of the cppc;site . ... ·• team through fellowship grrnt s ere being mode. Nursing Education Five WHO nurse instructors l'.lre 1.1ssisting the Governmont in strengthening nursing educstion in Tuiwen. ·The programme started in MHy, 1952, with local parallel team members p!'l rticip8"ting in the teeching pror;rnm:ne. Locr.l teaching m!'terir..ls ore beine; prepared in the longuo.ge c.f.' the studonts, with the co-oper~tion oi' UNESCO. In addition t o instruction for bosic students, the teaching progronrne includes clossos for bospital. nursing edministra.tors ond heed nurses. The pr~ject aims to prep~e locol nurses for leodership posi tiona in oducr.ticn and adrninistr~1tion. Triple Va.ccine Production end Moss Irnmunizotion C'-'mpdin 0
In connection "AAi th triple VDCcine production end the mass imnunization cmnpaign E>J:;ninst diphtheria, pertussis end tetf'nus, W.H.O is givin<; technicf'l f'dvice on the production ot the biclogicr:l product end in the pl.uming for its moss edministrf\tion. UNICEF is providing equipment o.nd supPlies to enable lurtso scpl e prvduction o.f' the required vaccine at the Taiw"ln Provincial St3rum nnd Vnccin,e Lob orAtory, M~larie
and Insect Control
Consicle r F, ble progress hns been mode in the ·umoAssisted maL.1ri~ ond insect c ontrol projc~ct, During 1952, the houae.s of over 150,000 people wore sprayed with DDT. In 1953, it is estimoted thut the housos of obout 1, 500,000 people will be sprr..yed with DDT. This progromrne is leying the foundation i'or the eventuol er~?,dicEJtion of malari o from TAiwan. BCG The BCG co.mpai~n was continued by the Government throughout the yc,ar and the figures at the end of .1pril ware: Starting t c::;t Completing tost NGgotive .Vaccinated 1,927,865 1,721,066 1.235,058 1,230,291
The R-3gional Adviser lost vi sited the project· in Hny vfuen he inspecte d tube rculosis c ontrol fr•cili.ties in ma ny p tu~ts of Tviw.en 1.'1i th n vi ew to oss isting- the Government tc drnw
/up long-term pl•ms
VIP/RC4/2 Fnge 17 up lonr:-terrn ph!lS .f'or •mified tube rculosis •ontroi• Trnchom~
Contrcl
A uilot tra.choma treat ment project using UNICEF supdies wns initi>:•ted by {' ~VBO short-terrn co-:1sul tr.nt. The results h.r.ve now been propeily ov"ll'lia.tcd nnd - 1~ound t o be S> \tisi'Hctory. The Chv ernment is requestin~; UNICEF- assi~:tro1ce for an isl ~nd-wide mass campaign for which 11EO will f }.ve o fellowship plus t e chnic nl "'''vice and supervision. V.D. Control The :V .D. cc ntrol demonstrnti•Jn project planned fo · the Taipei-Peito.w-Keelun!; oren is being implmnented in conjunction l•lith the ishmd-wido ·moth:=- r vnd l.}hild V.D.· prc.ject f or which UNICE-F is providing penicillin and s.er c ~·o gi cr l hborat·ory equipment. ~' htJ mother and c ild V.D. proje-ct will bC1gin iri. Taichung ¥\here tho WHO/ UNICEF-~Jssist6d l'!CH pi.·oject is in opereti on. ·rh<J p < r c j e .Jt p rovides for a v :.m eroc lo (.:; ist, n surologist, ~. p11blic heG l th nurse, nnd a health educo::. tor. 1he venereologist h ns n ow b e en recruited. m d will soon be in pl Dc e . The ho:.: lt i·i P. d~rcnL, r i s new i n Taiwan e.nd r ecruitment of' th=:t r e s+. o f' tho te nm i s still c • ::;inf; on.
FIJI v i sit t c the t e rri t ory wos P"'i d by -~ J.te :;i c n~l Public Re~l th e.n d discussions W<J r e he li~ in r~~ s r, :. "!. t c wriy s in which the Or~~nniz n ti on woul '~ be '" 11l e to n.s si s t h :,t h Fi j i "md qdj a cent te rritor ie s.· A f ell owship wns r.;rant ed t c e n obl e a t ub,j r cul os :s i:J.ysi cinn t o ~- ttend th(~ }" ~m-F o ci f ic TubE1r oul o si s Con i'e r c::nc e : m d fl nothe :r fellowshi p Wf.IS F:VTr·rde :~ tc ~mabl e n. tube rculosis physi c ian t r; cnrry out studhJ S in tho Uni t~::d Kingdcrn. A third fell owship \'Till be aw::1rded .tc a physici en who will study psyohi11try. :~ r.!ministr,) t ~ r -~
HONGKONG
The ml'lternd nnd child he nlth pro ject in· Hc,nr;kong is designed .o s on e duc.nti.o!lfll en d demonstration pror; rmnme f •.:r the instructi c n of students, in-se rvice pf; r scrinel, p riv~t <:: proctiticners onrl pt:lrents, in tho bn sic princip les o f' child cr.ro. Although the internoti e:nei ter~ m V'N·G plrnned t o c cnsist cf 4 members, so t' ;:;r only the l\.1CH e ..(pert ond tenm.l e t;de r hn s c cmme nced v vork in ·. t he .. fic ld.~ .~·: She hr~s 'teen Cl:! rrying out r: .. prel imi n D:ry surv0y and p roc e edinr~ wit \ the progrr.r.me of t eoching m :.J dic :;~ l s tudents enri in-service iJCH pers onne l. It is exp e ch:~d thot the nuraing memb..; r s of tht' tcmm will s o< n r rrive .
BCG Th,; BCG pro,j~C• ct wns continued by the Gavernrilent t hr c ughout the y e'l r. Tho. :~Eli~ionr.tl Advis e r vi s ite d the pro ject in September rnd l)t:joembor 1952 whe n the pro j 0ct Wfl S modifi e d i n t 1.1 e lip.;ht of l o -:-~1
WP/RC4/2 Pege 18 CC1nditions. By ihe · end -of 1952, prec'ticGliy oll schocl children had been covered except fer new entrnnts. _ A house-tu~house campaign has been c~rded out since to test end ve<lcinr:te o.s many as possible of the pre-school children. The total figures at the end of' May were: St a rting test Completing test Negative Vnccin£>ted 245,687
208,840 50,721 56,220 (including 5,654 newborn)
Fcur teems worked throufShout the yeer end n fifth teem, for re-testing vaccinated children, has been set up recently. The target figure oi' children to - be tested in the first ye~r of' the~ project WP.S 150,000 to 200,000. The num~er actually tested in the first year Vfas 228,115 ond the number vaccinated was 49,473.
JAPAN Premature Infant Project The prem~ture infant project hns been initiated. The short-term consultant h &s mode his tcur and suT.litted l:Jis report. The three fello?rs hDve c·ompleted the first stage of their study tour. The plms fer equipping the premeture infant care demonstrAtion centre in Tokyo nove been prepared "lnd the su:-)-plies tc be proVirted b i · ~VHO ordered. Poliomielitis and Rehobi itation of Crippled Children The poliomyelitis and rehobilitotion of crippled children project hns been implemented. The short-term · consul tent mede her vi sit befo:re . the end cf' 1952 und submitted her report early this yeur. Three of' the five fellows who h!lve rt\cei ved nwa.rds hove arrived in the U.s .A., ond the others will soon proceed tor study. The buildint; progrAnnne for which equipm~nt wus r0que sted f'rom UNICEF has been p r1rtly completed. The UNICEF supply list h:,s been £~pproved end orders pleced. Institute of Mentnl Health A WHO short-term consultr•nt visited Japan to assist the Government in surveying the needs end the ovnil~ble .t~.cilities. The i'ellowshi'P ce.ndi (~nte~ recommended b:; the Government were ir,terv:iewed by him and were fcund tc be suitable. ·$5,000 worth of equipment and medic~l liternture e.re under procurement.
/Tuberculosis Control
WP/RC4/2 Page 19 Tuberculosis Control The Chief of the Tuberculosis .Secti co n at HeAdquarters end the Regional A:lvist:r visited Japan in i~l~ril tv see the tuberculosis control programme in action. The assist9nce given to the Government by the Organization is limited to fellowships at present.
LAOS Public Health Administrl'1ti on Fellows :~.ips
Eight Lootian fellows ore studyirw; at the Ecole de s Of'f'iciers de Sf1nte in Phnom.-Ponh, Cambvdi!'l. undfH" \\'HO f;1.1Spicos •. Three will greduflte in 1955 end five will graduate in 1956. The socio-economic conditions, ns well as the he alth problems, ore approximately tho samG in Laos end C2mbodia, nnd tho cost of the s<::• i'ellowships is considerebly lcwt-;r thHn th?.t cf tr o ininr~ outside the Rq~ion. This is the first instance in which fellowships hAVG boeln granted fe-r undergrnduate trdning. There is no medicr.l school in Laos. Yt~ws
Control
The ·v~HO personnel o.rrived in the country in Jantm.cy. At the sto.rt of the pror:;rrmme • only 65% of the population in tho aree essirnod to tho h1t0 personnel could be exemined. This was increased to 18%, and lnter to 93. 5%. I:Qclement We8ther, poor communic~;:-tions r!ld the unsHttled stat r:J o.f.' the outlying eres.s hrwe slewed down the progress of the work.
The Organizetion has been nsked f.)r l) <"lvico in connection with the 'JUroh>~ Se of' supplips of DDT which will be used in : both Mac~:~.o and· Portuguese Timor. Visits to Mecf)o w•1re mr: ·1e by ·the Regi onal Dir·ectcr and a Re gi onal Public Hee1th Administrator. HRtericls denicting the ectiv~ties of the Organization ,,..ere furnishad. A fellowship wes awrrded to en!'lble a nhysicien to rJttend th0 Pan-Pacific Tuberculosis Conference<!
MALAYA
MCH A moternel ond child health projeet criginolly scheduled for 1952 and 1953, nnd f or which budget ery provisions were mnde, has been withdrawn. · The prevision, howov(Jr, of n project in rural he~Jlth in tho rcrm of o rural he£-lth trdninr, centre will go: n long way t oward the provision of services for met hers €\nd childre n ~~;~nd the study of how best to m•"3et the local problem pertr1ining to these l<~rQups of' the population.
/Nursing Ed.ucoti.:-m
wP/RC4/2 Pago 20 Nursing Educe.tion The five members of the nursing educetiun "teom ere continuing to strengthen undergraduAte nur£ing education end ·in-service tr:·dning f'Gr grr.:dunte nurses nt the training school in Penang. ·· ;~ WHO mule nurse instructor has been rssigned to this project. He hns been of velunble Assistance in inter~reting the role of the mnl8 nurse. Increased emphasis h8S been placed upon ward teaching and the correlati0n cf classroom tenching .and clinical experience. ~fidwifcry training has been included in the project ;nth the assignment of a tutor to develop this phase of the training in Ku<iia Lumpur. UNICEF has pro·vided nddi tional teachin~ equipment.
BCG year. BCG work was ccntinued by the Government durinr, the Tho tctol fiRures nt 30 April 1953 woreaStarting test Completing test Nee;ative Vnccinated 562,362
527,157 279,753 302,296(including newborn)
NETHERLANDS NE'iV GUINEA Arrangements were mncle fer a m•·lariclogist to visit the mal=·rb pilot project en thc-J islend of Ifind(;ro, in the Philippines. A hospitAl mr.tron attended the Nursing Edue11ticn Seminvr held in Tciw"n in 1952, end e physician attended th3 Pon.. P8ci.f'ic Tuberculosis Conference held in Maniln in 1953. During e visit by r H.egion(Jl ?ublic Hef11 tli Adnlinistrr.tor, discussions took plcce concerninr: wr;ys in which the OrganiZF.ltion \Vould be eble tc 9 ssist the Government. Subsequently, Arr~ngements were completed fer a visit by the Regional Tuberculosis Adviser in ~ugust of 1953. NORTH BORNEO School of Nursing
YmO nurse instructors ore ccntinuj.ng instruction in the school of nursb~ ond in ~:>Ublic heelth clinics, With incr::Jasing emphasis upon clinical experience. AssistAnce hes been given to the training of sanitflry inspectors. Transfer of this project tn another locality is now under negotiation. Environmontol Senitation The environme-ntRl se.nitf'tion project, the agreement
/for which wes
V'iP/RC4/2
Page 21 for which vms signed on 2 Ua rch 1953, Pt:ovides fer a ssistence in studying 1;1nd surveying prohlems reh.ting to environmental sanitation, especir>lly' those of sewage o.nd water in selected urban communi ties. These communities suffered serious devast~tion during World War II Dnd ere b13ing rehabilitated 1:1 s part cf a general plrn for development of the terri tory. It is oxpec.ted thet the project will start operations on 1 Oot:.::ber 195:3 and will l~'lst f'Jr o period of 2 years. 'WHO will essist the Government by pro"\'iding o short-term c :n sul te-nt to make on initial survey end recommendr.!tions, end two eP..gtneers who will mDke detoiled surveys, designs .und plans f'or s ani tor.{ faoili ties. Malc.rio Control Following P.notht:lr visit cf the Rer:;ionol lwlalarie Adviser, negotir>tions for the imt:JlementAtion of' a WHO-assisted rr.nhria pilot project in this country htWG been resumed. The chief objectives of this project nro the d~teminction of the most effective end economicnl xaen.ns of' contr lling mn1a.rio in tbe oou:ntry and the training of local personnel.
BCG The ;{ng:ionn.l Adviser visited North Borneo in Marcp. and discussed the BCG campeign ·with the Government and illHCEF. As a result it was decided to postpone the campaign until conditions are more fr.vourable.
TERRITORY CF PAPUA 1\ND NEW GUINEA . Fellm•rships were gronted to enable D nurse to ·attend the Nursing 'Educvtion Semincr hold in Taiwan., and tc enable ·-e tube·rculosis specinlist to ottend the Pan-Pacific Tuberculosis c.,nf-e·re:n.:ce .hehi in Mcnilc. The tuberculosis specialist loter proceeded on a -lffiO· f3l1ow.. ship to Europe to visit Sc!mdinavir. and the United Kingdom. It is hoped thet the Goverr.J!Jent will be able to pa.rticipa~e i!). yaws. rqse.arch end o. drG.f't outline has been furnished by the Organiieti'Ori. · ·It is planned thet the .Regi·on~l '·dvi sers on Malaria. end He.al th Educetion will v'isit· the territory ls.tor this year in order tc discuss in detail the ways in which the Or.g~mization cculd assist with he,<?.lth educrtion and mal ari n cant rc 1.
PHILIPPINES University of the Philippinds (Institute of Hygi€ne} ,An ggr-eement WflS
si1med by WHO, the .Johns Hopkins University
·1md the University o1~ the Philippines, whereby ·!.m' exchange of stt1ff
would bE! (:'i.t'f'ected •• The Rockefeller l''oundaticn ossisted th6 ·University the ?hilippine,S .h]. regard tc; the local .costS \Vhich Would be needed in connec<tiou viith ·tho· Orgfmizetion' s essistance. kocor.dim: t·,., the r.rnngomc:mts mr: ic, the ·;:'lr~f'essors of ?iTilblic her.l·th cadminist;ction and
of'
/public her•l th engineering
WP/RC4/2 Page 2~
public heolth en~insering of .t he Johns Hop)dns Uni~ersity School of Hygiene and Publ~c He8lth, engaged es short-te~ consultents. 'Jtrould visit the Institute of Hygiene in June 1953 Ellld mnke recommendotions concerninr.; the teaching of their respective subjects. The u~an is for Johns Hopkins' Associ'8te Prcfossors of Public Health !dministration And Puolic Health Engineering ~ c arrive ot the Institute in or obout July of 1953 ond for the opposi 'tie numbers the some subjects to proceed from the Institute to Johns Hopkins in September of 1953,
on
Due tc reesons beyond the contr~l of the Orgenization, there hns been o del,.,y in the nrri vel of the Johns Hopkins personnel. Orders have. been placed for supplies end equipment E~nd these should ar··ive at the end c•i.' 1953. MCH The MCH demc·nstrvtion project (Rural Health Demonstration and 1'ra.ining Centre) assisted by WHO end UNICEF in 19Sl, nc longer receives ASsistroce. It is cont,inuing t(J give excellent demonstration end teechinv, services to personnel being trained 1c·r rurnl work, In view cf' the loceticn cf the Regional Office in Manila, the services of our technic3.l staff have be\'m AVniled of for em sultation by the stnf'f of this CEJntl"e. Mfdwifery Tr~ining
Plons are under way fr1r v7HO end UN·ICEF ossistence to be given for the improvement of' the training of midwives, J~ nurse-midwif'e consultant, schedulod to arrive in the lDst quarter or this yev.r, will assis.t in n, survey of the ove!'P.ll midwifery situr.tion in the 'Ph~lbpines c.~ld will map out a suitable training programme for this category of health worker. Bilharziasis Control The first phase of the bilhurziasis control project, consisting of c survey end recoili!Tien ~ati ons for the c·:mtrol of tr.is disease, in the Philippines was completed by r. team of WHO experts on 30 September 1952. One of the recommenr:letions o£' the team wes the initiation of A pilot project which would study Fnd develop c r:ntrcl methc,ds · for the disease. This reccmmendo_tion was P- dopted by the Government find assi st!'lnce f c; r its implementation •as requested from \1HO. On 16 July en Agreement was signed by the · Government for such assistance. It is plam.ed to provirie e t e am of three internAtional personnelJ an epidemiolop,:ist, " z oologist ond n public hef'lth engineer, tog<3ther witi1 scm;,~ equi l)ment and supplies. The project ha.adqunrt'o-:,·s wi],l\: .:, ' "' ":'!:c:; :t~~"•·-: ., (' L";y:;o,::. ~. •;hioh bilherzhsis is highly endemic, the Government hAs , awBrded a contract for the c t•nstruction of .n leborntory heedquRrters in
/tho Municipality of
vVP/RC4/2 P~:~ge
23
the Municip0li ty or Palo, Lf'Jyte. The :public henlth engineGr is already st work and the two other te:1m members ar6 being recruited. It is expected that they will report f0r duty oy 1 September 1953.
This project will lest fvr r, period of three to six years and will .fulfill o long f<:Jlt need in the Vlost6rn Pa.cific for besic end epplied study on this import~nt endemic dise"'se.
WRO-assistet! mdnrir pilot project in Jl~indcr·:> is prof~rtissing very s~tisfa.ctorily. Th.<:; preliminr•ry results of the first Di11' sprryin~ cporotions indicete thl?t this method of c lmtrol would be :;ffecti vo. These preliminrrJ results hove been to.ken into considerrti on by the Government in '\';heir exp ~nded Jlll't la:ri.o ce-nt ro.l pro ;:~ rnmme.
lh'~
Du:t'ing 1953, ell tho malarious ccrnmunitias of the isl£>nd of Hindoro ( '3.1i:Cept t~-,e poorly · occessiblo cc:mmuni ties in the remote · interior) w.::ro sprayed with OOT, giving protection t•.) nt leost 112,000 ~)e ople. The project h1JS b>:•en utilized for the training _ :or be. th local and forai.gn mel ~rin ccntrcl personnel. It has not b0en possible to undertake a field trial with Dieldrin this yer-.r, b,'..!Cl:luse the su~ply of this insecticide w~s found unsP.tisfectcry and ·the trf\nsmission season hes ol reedy started.
BCG The BCG campaign h~s cc ntinued with· internctions l ossist~nce the volt.unE: cf wcrk dono has increased considerr;bly during the · y eo r. .~t the beginninc oi' t '1o ye pr, 10 teams wore working, where<~s, in .June 1953, 21 t aoms were working. In September 1952, 54,193 children were vr.c.dnoted wheree.s, in May 1953, 73 .. 211 were vnccinr.ted. The cumul·e ti'fe tobls r..t the end ol' Mny 1953 were:~1.nd
Startin:;: test Co~~letirl~ te~t
1,732,386 -
1:,446 ,dl9 822,024 8·17·-642
Negeti'lre Vuccini'ted Pon-Pnci·fic Tuberculosis Conf orence
The Philippine Government WAS host t o the PE~n-P (1 cif'ic Tuberculosis Conference.which wr.s held in Mn.nila in April. Refe r ence t c this c onfe rence hAS been made elsewhere in this report. Yaws Control 94% of . the work in SemDr, 9~/o of thot in Leyte end 52% of thf.l t .in Surig3o hos now been c cmpleted. Eight field tef.llllS hsva been in c.perl'tic!::'l. .<'bout 63% of the tot,l estim':'~f:ld popul~tion of the 11rees of otle.rP.tio•J. wors exfmined . The w(; rk hns been handicapped by /difficult terrein end
WP/RC4/2 Pn@3 24 difficult terrain ond b~:~d woother. The sonp supplied by UNICEF waa dis.t ributed t c yo.ws cases md cc.ntacts. thus helping to develop desire ·for .cleflnliness.
A short-tei'Jll cc-nsultant in ht·spitP.l architecture visited the territory ond furnished ~dvice on the hospital building ?rogrpmme. Lvter, during his j ourney home, further ccnversotions were carried out in Washingt0n, D.C.
S·'RAWAK
Henlth Education of the Public This project was tenminvted et the request of the Government after having beenm.cp:tation for less . then four months. · MnlArio Control pilot project in SarawRk is progressing The first round of residual spraying w:as carried out this ygnr. The Government hns accepted e. second intornetio:qel steff member fc 1~ the project. Upon the request · of the'Government, the duretion of WHO cssistcnce to this prc ject is being extended up to the end of 1955. This will pe rmit the project leader to A Ssist tho Government in the extensi on of the programme to the gre ~ ter p o rt of Sarewak, using the experience gnined in the pilot project. sntisfr.~ctorily.
The
m~lari~
BCG The internntionnl personne l · whc orrivod t c ossi s t the Government with the BCG oempeign on 2 July 1952 ccmpleted their work on 10 April 1953. BCG. work, leter combined with YFJWS control, hns been stP.rted oll over Snrewnk ond is being continued by the Government. The tnr~et figure of persons t e: ho teste d dul-ing this period wes '$0,000 e.nd. thu number ~:~ctuelly tested At 31 Mf:lrch 1953 wns 105,887. The torge t w~ s. therelo r e , excee ded by more thAn lOo%. The cumulntive t otals et 30 April 1953 we rua Starting test Compl eting test Neg~:~tive
116,363
94,843 40,118
Vaccinated
40,794(including new born)
The Regi qn !.'!.l Adviser visited the project in Marchand July. YElws Control The treatment of yaws was ~dertnken by . the kVHOjUNICEF BCG teem. The inte rn e1tion9l toe.m was withdrawn upon the successf ul c onclusion c f its work. The Government is c'mtinuing /with the ygws
YiP/RC4/2 Pege 25 with the yaws control r.nd BCG work. visited Se.rawak in July. The V.D. Adviser
SINGfoPORE University of' Mnlayu Considerable progress hr.:s been medo during the prst ye8r with the proje~t for assistance to the University of' M~laya. WHO lecturers in hoalth education, applied nutrition, and e,.,plied physiology and biostatistics have been Appointed. Due to the reorganization of' the University stef'f', a lecturer in industrial hygiene is nc longer required. It is hoped that bef'oro the end of' 1953, a lecturer in public health engineering will be appointed. Althcugh the University jecided to postpone the comnencement of the Diplomn of Public Health course until September 1953, the steff appointed during the yeer were able to cerry out e variety of very useful activities. Equipment and supplies to assist ~n the teaching of applied physiology and health education ~ve been ordered. With this considerable assistance frcm the Organization, it is anticip3ted thet on excellent course on public heolth will soon be offered by the University. The l~cturer in health education, in addition to assisting in the teaching of' undergraduate medical students, has assisted the University School of Education with both undergreduete and pcstgrBdunte studies. She hfls o.ssisted in orgenizing and conducting a summer refresher course fer social workers arrenged by the University. The hee.lth educetor has also assisted in the Teachers Training College end with adult educ11tion ,;;rcups. She hBs not only been Able to assist the Sing<.>pore Government but hss also attended meetings of' the Feqeration Health Council. The lecturer in applied nutrition who arrived recently, has bean Able to assist the Government by being guest member of the Singapore Advisory Council of' Nutrition. She also attended the Regional Nutrition Committee Meeting held in Bandoeng in June. The lecturer in biostatistics will arrive before the commencement of the academic yee.r 1953-1954. A fellowship hos been ~:~warded to the opposite number in biostatistics who is to continue the teaohing f'ollo"Wt,ng the wi thdrawvl of the WHO lecturer. Midwifery Training The Government pro§;romme for midwifery training is making c ,nsiderable progress. With the t1 ssi stance of' the WHO instructor·, a teaching prot;rrunrna has been organized 8lld local staff' ere being trained. One of the local rnidwives.~ill take a tutor's course this yee.r so that she will te fully qualified to continue the teaching pro~ramme ~fter vVHO ~ssist~nce is /withdrAwn. PlAns include
WP/RC4/2 Par~e
26
-:nthdra't'ffi. Plans include the develonment of domiciliary practice for students end refresher training for practising midwives. BCG BCG work has oontinued during the year and hes been carried out by the Gover"nment without international nssist~nce. The cumulative totds at 30 April l9fli3 were sStarting test Completin1~ t(1st Negative Vaccinated 88,519 83,1$3 33,359 34,471. (including newborn)
The Regional Adviser visited Sinf>apore twice.in 1952. PORTUGUESE TIMOR Please see M~cao.
VIETNAM
TJ'le Vv'HO public haal th administration expert left the country upon the terminntion ci' his c ::;ntrnct. SteJ?S are being teken to obtain a repl~;~cem,mt.
MCH The agreem•c:nt for the MCH demonstr~tion project is still under c cnsiderP..ticn by the Gov'Ornment. It is hoped that the project me,v be implemontc"d durin~ the cc;ming yof1ro Mnl .,~ r :L a e.nd
Insect Control
Upon the request or tho Government, WHO assistflnce in the: r.nlaria and insect cr.~ntrol project in Scuth Vietnrun was te rminn.ted on 30 June 19!1P3. BCG The BCG project wos intended to begin on 1 October 1952 but owing to difficulties in recruiting intorn~tion~l personnel it has unfortunately been postponed. It is expected that tJrl.s project will begin very soon. Owing t c local diff'iculties, the tuberculosis control pror;r::mune has als:~ been postponed t'or the present.
WORLD HEALTH ORG llHZA'l'lON RIDIONAL COMMTITEE
WP/RC4/2 APPENDIX 1 6th August 19 53 \rJESTERN PACIFIC RIDION
Fourth Session Tokyo 3rd to 8th September 19.53 I - International L - Local LIST OF RIDIONAL OFFICE POSTS ORGAIHZA'I'IONA·~
l'
POST ! Regional Director
NATIONALITY China
OFFICE OF REGIONAL DIRECTOR
I Administrative AssistAustralia ant L Secretary Vacant Public Information I Public Information Officer L Information Clerk L Secretary I Medical Director I Regional Public Health
Australia Phili ppines Philippines Philippines China and New Zealand Chile Philippines (2) and USA (1) Philippines
BUREAU OF HEALTH SERVICES
Administrators (2) I Stati3tician & Programme Evaluator L Secretaries (3) L Clerk-Typist
Advisory Services
I Regional Adviser on Not yet reported Education & Training for duty I Regional Adviser on Health Education of the Public USA L Fellowship Assistant Philippines I Regional Malaria Adviser Philippines I Regional Tuberculosis Adviser UK I Regional Venereal Diseases Adviser UK I Regional }1CH Adviser Australia I Regional Environmental Sanitation Adviser USA I Regional Nursing Adviser USA J: OJ.'
Stt::nogra}-n.i.c r'ooJ. Advisory Services
L Clerk/Stenographers ( 6)
Philippines (5) and USA (1)
WP/RC4/2 APPENDIX 1 Page 2
P0 ST OFFTr.F OF 'IDI1JNISTRATION AND FINANCb Budg~t,
NATIONALITY Norway China New Zealand UK China
I Administration & Finance Officer L Secretary · Budget & Finance Officer I Finance Officer I Chief Accountant L Accountant . L Assistant Accountant L Accounts Clerk L Clerk/Stenographer L Budget Clerk L Cashier I
Finance
&
Accounts
Philippines Philippines Philippines Philippines Philippines China UK
Person...nel
I Personnel Officer L Personnel Records
China Holland Switzerland China Philippines Philippines Philippines Philippines Philippines China Philippines Philippines Philippines Philippines
Assistant ...)~.4 s.Y:..· ..__._
-
--
I
I
L .L
L L
L
L L
L L L L
General Services Officer Translator (English/ French) Translator (English/ Chinese) .t'ro curement Clerk Supply Clerk Travel Clerk Registrar Regis~ry Clerk Ma:U Clerk Librar:l Clerk Clerk/Typists (4) Telephone Operator Custodial Staff (10)
WOR.LD HK\LTH ORGANIZATION ROOIONAL CO:Mr-'IITTEE Fourth Session Tokyo 3rd t.o 8th September 1953
WP/RC4/2 APPENDIX 2
6th AugustJ
1953 ·
WESTERN PACIFIC REGION
GEoGRAPHICAL DISTRillJTION OF INTERNATIONAL ST.L'G'.F WESTERN PACIFIC RIDIONAL OFFICE -WORlD HEALTH ffiGANIZATICN COUNTRY ............... REGIONAL OFFICE
~
F!EID 3 2 1 . 8
TOTAL
Australia Belgium EoU:via Ce.nada
3
6 2 1 8 1
Chile Chir:a DerlJllB.rk
l
3 2 1 2 2 1 1 1 1
3 2 1 2 2 2
Finland France Greeca Holland Ir..dia Ns~·J Z aa.1and. N Ol'"'t~-~- j.,.
1
Philippines Spa~r:.
2 1 2
1 3 2
3 1 1 4
s!rit.zerland United Kingdom United States
1 4
3
5 TOTAL:
l 2 8 8 f:iJ
5
Short-·.•term consultants from tlle following countries were engaged du...""ing the year :
Svreden
l
Switzerland United States
1
6 1
United
K~dom
WORLD HFALTH O:OOANIZA. TION RIDIONAL COMMITTEE
WP/RC4/2 APPrnDIX 3
6th August,
195:3
WESTERN PACIFIC RIDION
Fcurth Session Tokyo 3rd to 8th September 1953 GEOORJ\:PHICAL DrSTRIBUTION OF LOCAL STAFF
-'---------------------COUNTRY China
WESTERN PACIFIC REGIONAL OFFICE -WORLD HEALTH ORGANIZATION
RlDIONAL OFFICE SECRETARIAL CUSTODIAL 4
FIELD SECRETARIAT 1
- !O'flL
5 38
Philippines United States
?.8 2 34
10
2 10 1
TOTAL:
45
WP/fte4/2 • APPENDIX 4 6th August !;~
Rmi ONAL COM>IT 'ITEE Fourth Session Tokyo Jrd to 8th September 195.3
WESTERN PACIFIC RIDION
CIASSIFl CATION CF FELIDWSFJIFS AWARDED ACOORillNl TO FIELD OF STUDY AND SEMDJARS HELD DURING THE REPORT lERIOD AND IJ:ST OF COUNTRIES FROM" WHICH"· FELLOWS CAME FIELDS OF STUDY NUMBER OF FE:LLOOHIP.3
1. Biological Standardization 2. Environmental Sanitation
l
1 l 2 l 2 l l
.3. Histopathology & Tissue Culture 4. Hospital Administration Inspection of Drugs
s.
6. Malaria Control
7. Medical Social Worlc
s. 9. J.O.
Medical Statistics Undergraduate Medical Training Midw.U'ery Nursing Administration In~nts
8 1 1
u.
12. Nursing Care of Prem ture 1.3. Obstetrical Nursing.
1 2 l
lA. Occupational Therapy 15. Paediatrics 16. l?. Physiotherapy Public Health Administration Tuberculosis Control
3 2
5
lB.
3 .3
19. Venereology SOONARS 1 PARTJ:CIPATION IN
1. Mental Health Seminar 2. Nursillg Education Seminar
19
(so far awarded)
7 J.8 84 or 3'11 fel.lowship months
3. Pan-Paoi.fic Tuberculosis Con:ference TOTAL
wP/RC4/2
ANNEX 4
Page 2
Australia
cambcidia Japan Korea
Laos
China (Taiwan) Fiji Hongkor~
Macau Malaya Netherlands New Guinea New Caledonia New Zealand
North 1brneo Pacific Islands Trust Territory Philippines Sarawa.k Singapore Territor,y of Papua and NC";T Guinea Viet-Nam