Lessons from the tsunami
The Bulletin interview with Dr Samlee Plianbangchang.
Dr Samlee Plianbangchang, 65, earned his medical degree from the University of Medical Sciences, Bangkok, in 1965 in his native Thailand. He gained his Master of Public Health and Tropical Medicine (MPH & TM) degree in 1970 and Doctor of Public Health (DPH) degree in 1972 from Tulane University in the United States. Dr Samlee joined WHO in 1984, where he has held a number of positions at the Regional Office for South-East Asia. He has also acted as senior health adviser to the Thai government. He took up the post of Regional Director of the South-East Asia Regional office in March 2004.
A year after giant tsunami waves struck six of the 11 Member States in WHO’s South-East Asia Region on 26 December 2004, WHO has boosted its ability to respond better to a disaster on this scale. Reconstruction is advancing in Sri Lanka, Thailand and India, although a polio outbreak in the Indonesian province of Aceh and the first human cases of avian flu in Indonesia have slowed progress there.
Q: The tsunami of December 2004 was unprecedented in that a single emergency affected six countries in the South-East Asia Region. What have you learned and what could have been done better?
A: We should have made our emergency preparedness programme more effective by increasing the adequate number of competent staff. We should have had an emergency preparedness and response plan for WHO offices in all countries in the Region. We also learned the importance of enabling people and communities to help themselves in the first hours of an emergency before outside assistance can reach them. We at WHO did very well in helping the countries affected by the tsunami in their relief operations. However, WHO could have done better if there had been adequate funds for immediate use, a set of standard operative procedures to be used by WHO country staff and better coordination within WHO and between WHO and other organizations. We are addressing these issues now.
Q. Have countries rebuilt damaged health facilities?
A: They have done a lot, but a lot more remains to be done especially in Aceh in Indonesia, and in Sri Lanka. Work has slowed down in Aceh because of the recent polio outbreak in Indonesia and the first outbreak of human avian influenza in that country. Adequate funds have been pledged for Sri Lanka with support from many international agencies, including WHO. The plan in Sri Lanka is in the first phase of implementation (there are three phases – recovery, rehabilitation and reconstruction). Thailand has nearly completed reconstruction of affected health facilities. India has almost completed reconstruction on the mainland, but a lot remains to be done on the Andaman and Nicobar Islands.
Q: Did WHO send staff to help with the reconstruction?
A: We have been helping governments formulate plans for rehabilitation and reconstruction and our staff in those countries are also advising them on how to implement the plans. WHO is working with international agencies, health ministries, as well as education, defence and interior sectors in these post-tsunami operations.
Q: Your Region has been affected more than any other by new emerging diseases. What are you doing to ward off an epidemic of avian flu among humans?
A: We are not complacent, but have responded quickly to help countries prepare national influenza pandemic preparedness plans. These country plans are at various stages of development. Certain actions have already been undertaken to help countries implement what needs to be done in a timely manner. We are in close collaboration and have developed a joint strategy with the Western Pacific Region of WHO. We are stockpiling antiviral drugs and exploring the possibility of developing an avian influenza vaccine for humans. More health staff in countries are being trained in outbreak investigation and laboratory work. We host regional meetings so that countries can share information and experience.
Q: What challenges do you face in building and reinforcing health systems?
A: Well-functioning health systems are vital to the development and implementation of public health programmes, such as on disease control, water and sanitation, nutrition and mental health. We need public health services that promote health for all and services that focus on poor, underserved and vulnerable populations. A key challenge is to train adequate numbers of health workers.
Q: What are you doing to tackle your Region’s heavy double burden of infectious and noncommunicable diseases?
A: We are focusing on primary prevention, mainly through health promotion and disease prevention. Countries in the Region fully participated in a recent conference on health promotion. Thailand has done a good job in this area, and currently the government is encouraging people to take regular exercise, have a healthy diet, lead a healthy lifestyle, and so on. Countries in the Region are tackling problems of drug addiction, smoking and alcohol consumption. Good mental health care is very important for prevention of noncommunicable diseases. There is a long way to go in health promotion, but some countries have got off to a good start.
Q: In some parts of your Region HIV/AIDS is spreading fast, spurred by tuberculosis. What are you doing to tackle this dual burden of infection?
A: At the Regional Office the two programmes have been put together in one unit under one regional advisor to integrate their activities. We try to encourage countries to do the same, but in reality the two programmes are still separate at country level. Therefore, we organize Regional meetings and bring the country staff from both programmes together so that they can talk to each other and when they go back they can cooperate more.
Q: Antiretroviral (ARV) drugs have become more available to people with HIV/AIDS in your Region, where has delivering treatment been successful?
A: Only Thailand has achieved its ‘3 by 5’ target [to get ARV treatment to 3 million people in need by the end of 2005]. Our Region is supposed to reach the target of 400 000 people receiving treatment, at present we have achieved only 90 000. It will be very difficult for the Region to achieve the target. One reason why we can’t get treatment to people faster is the lack of drugs at affordable prices. Also, to move fast we need to train a lot of health staff to deliver quality treatment properly. Without properly trained staff it could be dangerous and under these circumstances no treatment is probably safer than treatment.
Q: Will your Region halt transmission of polio by the end of this year, and what efforts are being made to tackle persistent pockets of polio in India?
A: In India we are optimistic that we can cut transmission by the end of the year. I am not sure we will halt transmission in the whole Region as there have been more than 250 cases in Indonesia this year, so we have to be careful. But the strain of polio just found in Indonesia was not local, and the indication of importation from elsewhere gives us some hope that we might soon halt transmission there too.