(WPR/RC24/SR/5 )
SUMMARY RECORD OF THE FIFTH MEEI'mG
Queen Margaret College, Wellington Thursday, 30 August 1973 at 9.00 a.m.
CHAIRMAN:
Dr C.N. Derek Taylor (New Zealand) CONTENTS
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Statement by the Cha1 man ." ...................... "...................... " ....... "",, .. .
129 129 131
Consideration of draft resolutions ••.•.••.•.••••.•.••••.•••• Drug dependence ........................ """ .......... " .............. "" ........ " .. "" ........ ,, .. ..
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Comprehensive and coordinated teacher training programme for health personnel ...................... " ................ .
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REGIONAL
CO~1NTTTEE:
'I'WEN,!,Y-FOURTH SESSION r'
Fifth Meeting Thursday, 30 August 1973 at 9.00 a.m. PRESENT I. Representatives of Member States AUSTRALIA CHINA Dr H.M. Franklands Dr R.N. Cumming Dr Chen Hai-feng Mr Chou Shan-yen Professor Shih Chen-hsin Dr Chang Kuan-hua Mr Tsao Yung-lin Dr D. Singh Dr J. Laigret Dr Teruhiko Saburi Dr Rintaro Okamoto Professeur Agrege Sok Heangsun Dr Kadeva Han Dr My Samedy Dr Phouy Phoutthasak Dr Tiao Jaisvasd Visouthiphong Tan Sri Datuk (Dr) Abdul Majid bin Ismail Dr S.K. Mukherjee Mr Onn bin Kayat Dr H.J.H. Hiddlestone Dr C.N. Derek Taylor Dr G. Blake-Palmer Dr R. Dickie Professor C.W. Dixon Dr A.N. Acosta
FIJI FRANCE JAPAN KHMER REPUBLIC
LAOS MALAYSIA
NEW ZEALAND
PHILIPPINES
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PORTUGAL REPUBLIC OF KOREA
Dr J.B. Duarte Pinheira Dr L. Amarchande Dr Sung Hee Rhee Dr Sung Kyu Ahn Dr Kyong Shik Chang Dr Truong-Minh-Cac Dr Pham-Van Dr Nhan-Trung-Son Dr Ho Guan Lim Dr J.L. Kilgour Dr G. Choa Dr Mr Dr Dr
1
REPUBLIC OF VIET-NAM
SINGAPORE UNITED KINGDOM UNITED STATES OF AMERICA
J.C. King F.S. Cruz M. Kumangai J. Nunn
WESTERN SAMOA
Honourable Seiuli Taulafo Dr J.C. Thieme Mr Faapoituulao Atoa
II.
Representative of Associate Member PAPUA NEW GUINEA Dr M. lVainetti
III. Representatives of the United Nations and Related Organizations UNITED NATIONS AND UNITED NATIONS DEVELOPMENT PROGRAMME Mr W. Hussey -
UNITED NATIONS CHILDREN'S FUND .-~
Mr A.H. Aslam
IV.
Representatives of Other Intergovernmental Organizations SOUTH PACIFIC COHMISSION Dr Anne-Laure Bourre
V.
Representatives of Non-Governmental Organizations INTERNATIONAL COUNCIL ON ALCOHOL AND ADDICTIONS INTERNATIONAL UNION OF PURE AND APPLIED CHEMISTRY Mr P.J. Reid Mr H.V. Brewerton
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INTERNATIONAL DENTAL FEDERATION INTERNATIONAL COMMITTEE OF C)l,THOLIC NURSES INTERNATIONAL COUNCIL OF NURSES INTERNATIONAL PLANNED PARENTHOOD FEDERATION INTERNATIONAL FEDERATION OF PHARMACEUTICAL MANUFACTURERS ASSOCIATIONS INTERNATIONAL SOCIETY OF RADIOLOGY WORLD VETERINARY ASSOCIATION VI.
Brigadier J. Ferris FUller Miss P. Dudderidge Miss T. Burton Dr R. Black
Mr P.D. Coyne ~
,
Dr G.D.T. Harper Mr R.C. Watson
WHO Secretariat DIRECTOR-GENERAL SECRETARY Dr H.T. Mahler Dr Francisco J. Dy
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1
STATEMENT BY THE CHAIRMAN
The CHAIRMAN extended a welcome to Mr ASLAM who was representing UNICEF at this meeting. The Chairman pointed out that the tentative schedule of meetins_ showed some free time, but representatives were reMinded that this was only tentative and would be amended as fCc~~d necessary. 2 CONSIDERATIOM OF DRAFT RESOWTIONS The Committee oonsidered the following resolutions: 2.1 Annual Report of the Regional Director (Document WPR/RC2~/WP/1)
Deoision: The draft resolution was adopted (see resolution WPR/RC24 .R1). 2.2 Resolutions of regional interest adopted by the Twenty-sixth World Health Assembly (Document WPR/RC24/WP/2)
Dr CHEN (China) said that the prinoipa1 atand of the Chinese Government in regard to nuclear testing was clear and consistent. The Chinese delegation to the Twenty-sixth World Health Assembly had explained the stand of the Chinese Government in explicit terms and voted against resolution WHA26.57. He pointed out further that the International Health Regulations had been Signed by the Chians Kai-shek bandit clique during its usurpation of the lawful seat of China in this organization. Therefore any signature by that clique was illegal and null and void. Dr Chen asked that this statement be recorded tully in the minutes of the meeting. Decision: The draft resolution was adopted (see resolution WPR/RC24 •R2) • 2.3 Coordination within the United Nations S stem: (Document WPR C24/WP/3) General Matters
Decision: The draft resolution was adopted (see resolution WPR/RC24 .R3) • 2.4 Disinsection of aircraft (Document WPR/RC24/wp/6) Decision: The draft resolution was adopted (see resolution WPR/RC24 •R4 ) • 2.5 water on international f1 ts (Document
Dr KING (United States of America) stated that the Committee might wish to strengthen the resolution and suggested an amendment to the second paragraph. A further amendment was proposed by the United Kingdom.
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It was agreed that a revised draft would be prepared for consideration of the Committee. A revised draft (document WPR/RC24/wp/4 Rev.l) was submitted to the Committee and adopted (see resolution WPR/RC24.R5). 2.6 Quality of food on international flights (Document WPR/RC24/WP/5) Dr FRANKLANDS (Australia) referred to the third preambulatory paragraph and proposed that the word "such" be deleted and "notified" replaced by "reported", the paragraph to read: "Conscious of the growing numbers of passengers at risk in flights, and knowing that not all such cases are reported". Referring to the operative paragraph, he suggested that the word "steps" in the second line be changed to "measures" and "so as" in the third line amended to "and", the paragraph to read: "CAllS UPON the Regional Director to request the Director-General to take measures to up-date the 'Guide to Hygiene and Sanitation in Aviation' and to establish international standards ••• " In sub-paragraph (4), he proposed a comma after "consumption" and the words "Of food destined for meals on international flights" moved to the next line as this phrase was not really part of sub-paragraph (4) but was the final line of the operative paragraph. Dr KING (United States of America) said that his delegation was interested in this particular resolution and felt that the Regional Committee was taking a very important step in bringing it to the attention of WHO's central body. He had two alternatives to suggest: to present it to the Assembly or to the Executive Board. If the former step were taken, it would most certainly be referred to the Board of January 1975, which was.a long way off. He therefore proposed that the opening of the operative paragraph be amended as follows: "CALLS UPON the Regional Director to request the Director-General to bring this matter to the attention of the Executive Board so that urgent attention can be given to up-dating the 'Guide to Hygiene and Sanitation in Aviation' and to establish international standards ••• ", the rest of the lines being unchanged. The CHAIRMAN noted that the Director-General had no objection to this amendment. Dr PHOUTTHASAK (Laos) said that it would be more oorrect to replace the word "servis" by the word "a servir" in the last line of the French text of the draft resolution. There being no further oomments, the CHAIRMAN requested that the resolution be redrafted for the Committee's consideration at a later meeting. (For continuation of diSCUSSions, see the sixth meeting, section 2.1.)
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3
DRUG DEPENDENCE (Resolution WPR/RC23.R8): Agenda (Document WPR/RC24/7)
Item 15 of the
The REGIONAL DIRECTOR informed the Committee that the Government of the United States of America would be providing one consultant and funds for recruitment by WHO of another consultant to undertake the pilot study. The AW BOON HAW Foundation of Hong Kong, mi~~t also donate a sum of money for the study, which, it was hoped, would start in September in Malaysia and the Philippines. Following the completion of the pilot study, the possibility of inter-regional cooperation with the South-East Asia Regional Office, as requested by the Regional Committee at its twenty-third seSSion, would be explored, although the feasibility of doing so immediately was doubtful, as studies would still have to be conducted within this region. The next step would be the development of a regional programme in this important field. Dr KING (United States of America) said that the Committee might recall that his delegation had been very interested in this topic last year. It now wished to commend the Regional Director for formulating the plan for the pilot study and emphasized the importance which his Government placed on it. He regretted not being able to say that his Government's contribution had been received by WHO. He had been assured that prior to this point of the meeting, the money would have been deposited, but this had not been the case. His Government had offered the sum of US$ 5000 and a letter addressed to the Director-General had been prepared to this effect prior to his departure. His Government's small contribution plus the loan of a consultant for two months would, it was expected, get this project off the ground in the two countries mentioned by the Regional Director. He was happy to hear about the possibility of extra funds being obtained and trusted that the Regional Director would continue to seek money from other sources which could be brought into this project. His delegation considered that the leadership of the Regional Director had been of primary importance and the on-going support of the Regional Office would contribute to the success of the pilot project which would form the basis of long-term programmes in this and other regiOns.
Dr King also expressed his delegation's feeling that this type of pilot programme might be useful in opening up new opportunities in other parts of the world. The success of the efforts in the Western Pacific Region might well determine how far this type of mechanism could be employed in other regions, particularly to prevent drug abuse or, at least, reduce its harmful impact on society and fellowmen. His delegation agreed with the comments in paragraphs 2.3 and 2.4 of document WPR/RC2417 and supported the use of consultantships and fellowships in the area of prevention, treatment and control. The consultantships and fellowships provided a flexible, responsive means to increase the level of experience of individuals in planning programmes and establishing appropriate means of coordination which the WHO Regional Office could uniquely provide.
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The use of these mechanisms should lead to the development of several strong programmes which could be used to train others and build up prevention and treatment programmes. With careful development over a period of time, these focal points of interest, talent and experience might become the future nucleus for coordination and evaluation of programme activities in treatment, research and prevention. The REGIONAL DIRECTOR stated tha~ he was very pleased to hear the remarks of the Representative of the United States of America. The problem of drug dependence was considered as one of the greatest public health problems in the Region and countries were very interested in it. The AW BOON HAW Foundation in Hong Kong was a well-known philanthropic organization and its contribution of US$12 000 would be most welcome. Any contribution to WHO to assist the study would be appreciated. Dr OKAMOTO (Japan) said that twice, since 1945, his country had had drug epidemics - during the reconstruction period following World War II (1946-1954) when stimulants had been abused, and in the period 1955-1962 when youth had become addicted to narcotic drugs, such as heroin. The narcotics problem, particularly the illicit traffic of narcotic drugs, especially heroin, and their abuse by the Japanese, had shown a Significant change in recent years as a result of the measures taken. Since 1966, only a few heroin addicts had been discovered even in the delinquent quarters of the large cities in Japan. Internal organizations engaged in heroin traffic which smuggled heroin from abroad had been eradicated. Thus, counter-measures against the narcotics problem had achieved great success. However, a recent problem was the diversification of drug abuse. Lately, the abuse of hallucinogenic drugs, such as cannabis and LSD, and organic solvents, such as thinners and glues, was increasing among the younger generation. Further, sleeping pills and tranquilizers were frequently used, and there was a recurrence of stimUlant abuse. His Government was interested in WHO's activities in this field and would like to participate in the preliminary studies of 1973 and in the Working Group of 1974. Since the concept that illegal supplier and sufferer existed together was common to both this region and the South East Asia Region, an inter-regional project would be most useful. Dr PRAM-VAN (Republic of Viet-Nam) explained that in his country the effort against drug dependence was based on four measures; general supervision by a central interm1nisterial committee, intensive action against illicit traffic, health education, treatment of addicts. A number of beds had been reserved for addicts in all of the 68 national, regional and provinCial hospitals, which were adequately staffed and equipped. Training courses had been organized for physiCians, pharmacists and laboratory technicians, and a National Centre for the Treatment and Rehabilitation of Addicts, which would start operating next month, had been set up, since the final objective of any action in drug abuse control was to free the victims from their addiction and to enable them to find
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back their place in society. The Viet-Nam delegation expressed its gratitude to WHO, which had supported a request to the United Nations for four fellowships as well as the services of a short-term consultant. Dr HO (Singapore) said that he held a heretic, although not original, view that the role of medicine in drug dependence was limited to the treatment of the person when he was already physically wrecked. It had a very restricted role in preventing drug abuse and in breaking the drug habit. As it had not been possible to come up with very effective methods, primitive measures had become dominant in an attempt to solve the problem. The Singapore Government had passed a law in July this year, known as the Medicines, Prevention of Misuse, Act, the important provisions of which included the imposition of severe punishment, such as mandatory caning and imprisonment of drug traffickers. Persons found in possession of any of the controlled drugs in excess of certain amounts were presumed to be drug traffickers and were so dealt with. Drug addicts would have to be reported by doctors and regulations were formulated to restrict the treatment of addicts in approved institutions by approved doctors. A director, a police officer, who was a non-medical man, headed a unit known as the Central Narcotics Bureau and had powers to commit an addict, after consulting medical opinion, for treatment in any of the drug centres which had been set up. To glve effect to these changes in the law, certain services had been organized. Special counselling and treatment centres had been set up, special wards in hospitals set aside for the treatment of addicts requiring hospital treatment, and a former opium treatment island was being extended and reconstructed as a rehabilitation centre for drug addicts. Time only would tell whether the combination of enforcement and treatment and rehabilitation measures introduced by this law would succeed to stem the growth of drug addiction in Singapore. As medical men and, as a body, the Committee members had the responsibility to search for and provide the initiative to overcome this problem. He expressed support of the action taken so far. Dr FRANKLANDS (Australia) said that the World Health Assembly had urged Member States to promote programmes of education, epidemiological studies, prevention, treatment and rehabilitation, and research. Last year this committee had indicated its "lack of information on the nature, extent of drug dependence and on the availability of treatment and rehabilitation centres in the region." While the Regional Director had not been asked to obtain this information the Committee had asked for a progress report on the establishment of a pilot project to study the matter. This report indicated that action had been taken to negotiate finance for the project with the United States of America and other agencies but, in view of the urgency which exists in dealing with what has become a major scourge, the delay of 12 months was excessive and further delays could be expected before any progress could be seen.
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Therefore could the Regional Director indicate: (1) when the pilot study would commence; and (2) whether any questionnaires had been sent to Member States requesting information on activities which had already been instituted? The REGIONAL DIRECTOR replied that implementation had been delayed as no funds had been available for the project. There had been continuous contact with Dr King and other represen"~.~ives of the United States of America during the Executive Board and World Health Assembly. Until funds were provided those held by the Regional Office for other purposes would be used to start the project. In order to ensure continuity, funds had been provided in the budget for 1975. It was hoped that the study would start in September 1973. Data on the availability of treatment and rehabilitation of drug dependence had been gathered from the Philippines and Republic of Viet-Nam and some, although incomplete, information from Malaysia. The information was difficult to obtain and although Member countries did not like questionnaires, one would be sent out, if the Committee so wished. The CHAIRMAN suggested that Members could perhaps adopt the New Zealand policy, whereby information on any matter of interest was collected and sent to the Regional Office as it became available. This avoided the necessity for the Regional Office to make numerous requests for information. Dr MAJID (Malaysia) said that his Government had signed a letter of acceptance and that two WHO consultants would be arriving in Malaysia in September to commence the pilot study. Dr CHANG (Republic of Korea) stated that although drug abuse and dependence had yet to beoome a serious problem in the Republic of Korea his Government had taken action in March to strengthen the existing law on narcotics and drug abuse control, and would join and actively participate in the WHO programme and the United Nations Fund for Drug Abuse Control. Professor SOK HEANGSUN (Khmer Republic) stated that his country had set up a Directorate of Narcotics, under the authority of the Prime Minister, with a view to repressing traffic and eliminating the production, transformation and use of illicit drugs. This comprised a secretariat, a laboratory and a special police force. A large amount of narcotics - mostly passing through the Khmer Republic, where drug dependence was less of a problem than in many other countries - had been seized by the authorities. Dr BLAKE-PALMER (New Zealand) commented that some aspects of the problem upon which he had intended to speak had already been adequately covered by previous speakers and this gave him the opportunity to make reference to some outstanding pOints in the New Zealand approach.
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Fortunately, New Zealand had so far escaped the intensity of the problem in comparison with other countries but nevertheless it was present and had been for a considerable time. New Zealand had been very active since conclusion of the Convention on Psychotropic Substances and the Review of the Single Convention on Narcotics in developing organs for the fUll implementation of the intentions of the Conventions. A comprehensive review of legislation relating to all forms of control of drugs was in progress and a Misuse of Druga Bill was now being drafted. This had features in common with similar Acts in other countries and dealt with the control aspects of both narcotic and psychotropic substances together with a few other drugs which were tightly controlled. A National Drug Intelligence Bureau conSisting of representatives of the Departments of Health, Police and Customs, had been set up. The Health Department was responsible for the import/export licensing for narcotics and liaison with the other two departments was essential. Information about the proceedings of the Bureau had been sent to the WHO Regional Offioe and to WHO Headquarters, and this had enabled New Zealand to establish closer contacts with its neighbours to the north and east. The first report of the Board of Health Committee on Drug Abuse and Dependency had been widely distributed and the second report would follow shortly. Although New Zealand had not made a specific contribution to the Regional Office, it had contributed to the United Nations Drug Abuse Control Fund. New Zealand welcomed recent visits from officers of the United States Drug Abuse Service, from social workers engaged in the work of the Sabah Organization in Hong Kong, and was appreciative of the support and help received from Mr Garner of the Justice Department, Hong Kong. Like other countries it had been somewhat taken by surprise by the rather uncritical enthusiasm for methadone treatment for heroin dependence and had had to institute control measures over its dispensing. New Zealand welcomed assistance from other countries regarding the problems associated with drugs and was willing to make its training opportunities available to them. It had also very effective laboratory facHi ties. A background information paper had been prepared for the Director of Health, South Pacific Commission, entitled "Drug Abuse and Drug Dependency Some aspects of control with special reference to the problem as it concerns countries in a phase of rapid socio and constitutional change". Copies were available in the Committee Room.
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Dr PHOUTTHASAK (Laos) said that the following steps had been taken to fight drug abuse in his country: prohibition to cultivate opium, to smoke or use opium or its derivatives, as well as to produce or sell opium derivatives; repression of illicit traffic; health education; establishment, in September 1972, of a provisional centre for the treatment of addicts, which had already treated more than 400 patients with methadone. It was still too early to evaluate the effectiveness of those measures. Addicts were found mostly among the Highland population (opium) and among the young generation (heroin). The antinarcotics action had benefited from UNICEF assistance. A definitive treatment centre would be set up shortly and a short-term consultant had been requested to study the rehabilitation problem. Dr WAINETTI (Papua New Guinea) advised that drug abuse was fortunately not as acute and widespread in his country as in others. Apart from alcohol, misuse of drugs had been mainly confined to overseas personnel but it was recognised that the problem could increase. The importation of psychotropic substances was prohibited and it was hoped to restrict availability altogether. However, Papua New Guinea might need WHO assistance in training personnel to ensure the problem was kept under reasonable control.
Dr FRANKLANDS (Australia) said that Australia recognised it already had a drug problem and he would take this opportun1ty to outline the present position and future action to be taken. In 1969, a National Standing Control Committee on Drugs of Dependence had been established to consider steps which could be taken to combat the problem. Included among areas to be considered were legislation, trafficking, treatment and rehabilitation, research and education. It was first necessary to know what happened to those drugs which were permitted for ordinary use by the public, and to this end, a system had been established to monitor licit transactions. The system included regular reporting by importers, local manufacturers eto. of all transactions in narcotics and amphetamines from point of import or local manufacture to retail or hospital outlet. The system generated monthly reports which were forwarded to various State Health Departments and the Department of Customs. In addition ad hoc reports relating to any purchases could be provided on request. The monitoring system outlined trends in drug usage and minimised the risk of licit drugs being diverted to the illicit market. Information from the system was also used to compile Australia's annual report to the United Nations. Effective drug education was an aspect of major oonoern and to make implementation poss1ble the Australian Government had made available $500 000 a year during the last three years. Th1s was being increased to $750 000 for the 1973/74 financial year. Drug education centres had been established to disseminate information on drug dependence, to provide lecturing and other supportive services when required.
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New projects made possible by the increased allocation this year included services responsible for the promotion and coordination of community drug education programmes, the organisation of discussion groups etc. Further efforts to involve other sections of the community had been successfully aooomplished by the oonduct of a seminar seeking the cooperation of the mass media. From this had flowed increased liaison with the media, especially at top levels. Various films for showing at discussion groups eto. had be8~ produoed and these had also been used on the television net-work; 230 000 pamphlets of various kinds had been printed for distribution generally. A number of surveys had been conducted into the use and knowledge of drugs and attitudes to them. The findings were important indioators as to the "at risk" seotions of the population. The Australian Government had made a grant amounting to $7.5 million for 1973/74 for community mental health, inoluding measures to combat alcoholism and drug dependency. In addition, it had made a oontribution of US$ 100 000 to the United Nations Fund for Drug Abuse for 1973 and it was expected this contribution would be oontinued. Dr LAIGRET (France) pointed out that in spite of a marked taste for the consumers' society, Polynesian young people had not been contaminated as yet by drug dependence, although a few cases had been noted among young people reoently arrived from France. In view of this situation, his services were particularly interested in all available preventive methods. Prevention of imports of illicit drugs was the responsibility of the police and customs officers, and the legislation in force was essentially the same as in France. A recently established mental health surveillance centre would report all cases of inoipient drug dependenoe. Dr ACOSTA (Philippines) emphasised his Government's conoern about the drug problem by pointing out that, by decree, the penalty of death by shooting was imposed for the illegal manufaoture of dangerous drugs and this also applied to "pushers". Some people considered this too drastic but it showed how serious his Government viewed the problem. A Dangerous Drug Control Board had been established for the regulation of imports and to make rules for presoribers. Programmes for education and rehabilitation were being developed and the arrival of the WHO consultants was awaited so studies on drug addiotion could be conducted.
There being no further oomments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution for distribution at a future meeting of the Committee during this session. (For consideration of draft resolution, see the sixth meeting, section 2.2, and seventh meeting, section 1.1.)
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C(}II!PREHENSIVE AND COORDINATED TEACHER TRAININJ PROGRAMME FOR HEALTH PERSONNEL: Item 17 of the Agenda (Document WPR/RC24/8 Rev.l)
The REGIONAL DIRECTOR informed the Committee that activities at the Centre had started in January 1973. A two-week works~op.for deans and senior administrators of medical schools had been held in June and three other workshops were planned for the second half of 1973. A WHO medical officer had been assigned to the Centre in August 1973 to act as liaison between the Regional Centre, the Government, the Regional Office and countries in the Region. He would assist in the further development of the Regional Centre, in the establishment of national centres, in the setting up and running of the master's degree programme in medical education at the University, and in the organization of short courses both in Sydney and in other countries in the Region. He would also advise on the development of resource material for use in national health personnel training centres. Preparatory assistance was now being provided by the United Nations Development Programme which, it was hoped, would give further assistance in the years ahead. Dr OKAMOTO (Japan) stated that Japan had sent two teams to the teacher training centre and he was pleased to report to the Regional Director and the Australian Delegation the good effects of the courses. His Government now intended to establish its own national teacher training centre and he asked the Regional Director to provide WHO consultants to assist in this endeavour.
Dr CUMMING (Australia) emphasized that the Centre was to train doctors and other health workers in the science and art of teaching. Those attending courses were presumed to be already fully trained in their particular professional field. The first course, a two-week workshop in June had been attended by educational leaders from medical centres of the Western Pacific Region to discuss the determinants, contents and processes for the education of health personnel. Further courses in 1973 included a two-week course for medical teachers and a four-week workshop for future part time teachers and others with a proven interest in medical education. In 1974 deans of medical schools in the Region would meet to consider changes in medical education over the past decade and the role of teacher training. A twelve-month master's degree course would commence in 1974 to provide an integrated programme of basic work course and the opportunity for independent study. Australia considered the Regional Teachers Training Centre of the greatest importance to the Region as a whole. He then thanked the Regional Director and his staff for their close cooperation and understanding in the establishment of the Centre. Dr CHEN (China) stated that if the health of the people was to be proteoted the problem of health manpower had to be solved. To overcome the laok ot doctors in the rural areas large numbers of doctors had to
SUMMARY RECORD OF THE FIFTH MEETING
139
be trained. At present China had 79 university grade medical institutions training 40 000 students, 260 intermediate grade health training schools with 50 000 students and over 1000 hospitals training some 40 000 student nurses, midwives and allied medical personnel. To maintain this programme large numbers of teachers were required. The principal methods of teacher training were as follows: Firstly, practice in teaching and research coupled with field work, experienced teachers helping inexperienced ones, and full-time special teacher training courses in specific fields. Secondly, by teaching them practical knowledge and skills in keeping with the rural situation. During the last few years a new system of training had been introduced by the establishing of rural health stations outside the colleges. The organisation of mobile teams to tour country areas enabled students in schools to obtain more practical experience. Thirdly, there were three different organisations for the training of teachers: medical schools, hospitals and scientific research institutions. The period of training varied from three months to one year. It was recognised that the quality of the teachers determined the quality of the students' progress.
Dr KING (United States of America) noted the progress made by the Centre and reiterated his Government's support of the development of the Centre. He commended the Regional Director for the provision of assistance to the project. Dr King then asked the following questions: (1) How long would it be before the Centre covered teacher training in other disciplines? (2) How much of the Centre's resources would be devoted to "refresher courses" rather than the training of new teachers? (3) How would the "consultant services" be integrated into the operations of the Centre? (4) At what point would the emphasis shift from the workshop approach to the formal course-work approach? (5) The one year master's degree in medical education seemed different from the development of teacher trainers. The CHAIRMAN asked the representative of Australia if he would answer the questions. Dr CUMMING (Australia) referring to the first question stated that although this was an opportunity for a team approach to the supply of health services it was considered that to get the centre started and to give the Centre the highest possible repute amongst other institutions, training should initially be limited to doctors. Next year paramedical workers might be included. This step was up to the Centre itself in consultation with WHO and the Australian Government. It was not known yet what proportion of time would be spent on "refresher courses" or the training of new teachers. The workshop or seminar approach would continue for some time as it was expected 'to have only a small number of teachers with a full master's degree although there would be many part-time teachers who had some training and could
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assist at the national teaching institutions. The master's degree would be similar to that given by the University of Illinois, Chicago, a degree in the art and science of teaching. Dr KING (United States of America) thanked the Australian representative for amplifying the points and then asked if the Regional Director could comment on the third question. The REGIONAL DIRECTOR stated that as the centre was new, the best way of using consultants to strengthen the courses was still being discussed. The consultant months would be used not only to strengthen the teaching but also to evaluate the courses. Dr SINGH (Fiji) oomplimented the Regional Direotor and thanked the Australian Government for reoognising the need for the teacher training of professional personnel in the health institutions in the Region. Countries with medical schools needed the service and Fiji would be sending teachers to the Centre later this year. Dr CHANG (Republic of Korea) referred to the number of personnel trained by WHO and now working in the public health field in Korea. A rapidly expanding national health network had led to a shortage of trained personnel but with the establishment of the Regional Teacher Training Centre, Member countries might be able to establish their own centres. Dr Chang asked the Regional Director to consider providing assistance in the establishment of such a centre in Korea.
Dr MUKHERJEE (Malaysia) stated that his Government placed great emphasis on the teacher training programme. He thanked WHO for assisting the national workshop in Malaysia later this year and assured the Regional Director that the response from the Faculty of Medicine and the Public Health Institute had been most encouraging. Participants would be sent to a course at the Centre early next year. There being no further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution. (For consideration of the draft resolution, see the sixth meeting, section 2.3.)
The meeting rose at 12.00 noon