Health Action in Nepal

Transcription

1 Health ction in epal Health ewsletter inistry of Health and Population, Department of Health Services, Epidemiology and Disease Control Division. World Health OrganizationEmergency and Humanitarian ction ssue V, February 2006 Highlights Country Safe from Bird Flu and Little Risk of mport Laboratory Based nfluenza Surveillance vian nfluenza and nfluenza Pandemic Preparedness and Response Plan ock Drills marking the 8 th Earth Quake Safety Day Emergency First id in Conflict ffected Zones Building Capacity for ational Emergency Preparedness and Response ustralian Support to Polio Eradication in epal EDCD ews update Street heatre on alaria and Kala zar Preparation for First Round "ndoor Residual Spray" for alaria and Kala zar Control ational lliance for Canine Rabies Control BD DRCHUL Far Western Region RUP DEH DDEL DHUR KCH DO KLL BJH CHH BJUR BRDY HUL KLKO SURKHE BKE E R H L L JUL DLEKH JJRKO SLY O U idwestern Region UU D RUKU ROLP SKHUW SB PYU H DOLP RHK HCH BLU YD UL KPL BSU PRB PLP US KSK SYJ WL PRS Western Region HU LJU CHW ORKH DHD PRS epal Central Region RSUW UWKO KH LL BHK SDHU PLCHOK KVRE SDHUL BR RU H SRLH HO R DOLKH R E CH H P DHUS ERH BHOJ HU DH KU OKHL DHU SRH UDY Eastern Region KHO SPR SULUK HUBU KW Country Safe from Bird Flu and Little Risk of mport: inister K. B. Bista and State inister. Lama inister for griculture and Cooperatives, Keshar Bahadur Bista said uesday that the country is well protected from Bird Flu, and the overnment has been takin g necessary initiatives for controlling the risk. Speaking at an interaction program organized by Reporters' Club on uesday, Bista said that high alert should be maintained to control the disease and there should be an awareness campaign to the people about the symptoms and ways of getting the disease. He said that whenever cases were traced in any country, other countries around the world would work in concert to control the bird flu. hey would provide bird vaccines, the needed expertise and laboratory services. He said that if any case was traced in the country, the country would announce the state of emergency. he overnment has been controlling the import of meats, and there are quarantine checkposts in 24 places of eight departments, Bista said. He said that if the disease was communicated from one human to another it would take a pandemic proportion, but there have been no such cases till now. o be continued in next page SUSR OR PLEJU PCHEH R L JHP Health ction in epal (onthly Health ews Letter, ssue V, February 2006) Page # 1 of 7

2 Laboratory Based nfluenza Surveillance he ohp/ DHS / Epidemiology and Disease Control Division and ational Public Health Laboratory (PHL) have initiated laboratory based sentinel surveillance of influenza like illnesses, supported by WHO, Walter Reed / FRS Research Unit epal (WRU). he testing takes place in the ational Public Health Laboratory (PHL) in Kathmandu and in Bharatpur Zonal Hospital of Chitwan. n Kathmandu Valley, 13 sentinel sites include major public and private hospitals such as Sukra Raj ropical and nfectious Disease Hospital, Kanti Children Hospital, Bir Hospital, aternity Hospital, Birendra rmy Hospital, Birendra Police Hospital, Patan Hospital,.U. eaching Hospital, epal edical College, odel Hospital, Om Hospital and edicare Hospital. Selection of Bharatpur Zonal Hospital is strategic and was selected as a key surveillance site due to its location in what is considered a highrisk district for vian nfluenza as 40% of the country s poultry industry is located in Chitwan. n addition, Royal Chitwan ational Park is a natural haven for a large number of migratory birds. n order to monitor and help characterize influenza virus circulating in humans in epal, samples are collected from suspected influenzalike illness (L) cases and referred for investigation. For confirmatory testing, PCR is performed at FRS, Bangkok and remaining specimens are shipped to FOH for viral culture and molecular characterization. o be continued in next page Country Safe from Bird Flu Cont. State inister for Health and Population ani Lama said that if the birdflu transmitted from human to human, hundreds of thousands of people would die. He said that at present there are two laboratories for laboratory testing and the overnment is going to add three more. r. Lama said that the country has the necessary manpower to fight the disease but there should be positive messages at the local level. "We should maintain high alert even though we are out of the risk at the moment, he said. Director of Epidemiology and Disease Control Division Dr. ahendra Bahadur Bista said that the government had been mobilizing Rapid Response eam s in every 75 districts, and two laboratories of eku and Bharatpur Hospital are providing influenza testing. He said that the government has antivirals for treating birdflu in humans on stock for 100 people and if more is needed, the World Health Organization has committed for emergency supply. he Director of nimal Health Directorate, Dr Dhana Raj Ratala said that the investigations and surveillance in poultry are going on and no case of Bird Flu is found in epal. Dr D. D. Joshi reaffirmed that so far it was a pandemic in birds but not in humans. He said that the disease is not dangerous now for public health but there should be good diagnosis technique. he overnment has already started actionoriented tasks from onday but it was not sufficient. here should be training to the doctors working at the zonal and regional level hospitals, and the country should take initiatives for importing vaccine for birds. Bud Chandra Bista of epal Hatchery ndustry ssociation said that the investment in the industry was around Rs. 18 million and 62,000 people are directly associated with the profession while 400,000 people have managed to get indirect employment in the industry. n conclusion, the concerned national health and agriculture authorities confirmed that there is no need to panic, there are precautionary measures implemented and it is less likely that the bird flu would be imported to epal. (Based on the news paper articles published in he Rising epal and Samacharpatra, 22 February 2006) vian nfluenza and nfluenza Pandemic Preparedness and Response Plan Following the endorsement of the "ational vian nfluenza and nfluenza Pandemic Preparedness and Response Plan of ction by the inistry of Health and Population, inistry of Home ffairs, inistry of griculture and Cooperatives and the ational Planning Commission, the process for getting approval from the Council of inisters has been initiated. Health ction in epal (onthly Health ews Letter, ssue V, February 2006) Page # 2 of 7

3 Laboratory Based nfluenza Surveillance Cont. he reports on any significant influenza virus circulating will allow Epidemiology and Disease Control Division (EDCD) to evaluate the level of risk of an outbreak, plan measures to manage the risk, and to efficiently prevent the spread of the disease. ny antigenic drifts and shifts in influenza virus will be shared in the WHO Flu et to aid in annual reformulation of influenza vaccine. he initial project runs for 6 months from January 2006 and involves hiring of additional laboratory staff, personal protective equipment, administrative costs as well as training of concerned clinicians and laboratory personal of the selected institutions on patient information, case selection, demographic and clinical forms, specimen collection, performing the rapid onsite influenza tests, interpretation of its results, result documentation and specimen storage. mediumterm plan has been envisaged, under the financial assistance from sian Development Bank, a total of 6 districts (Jhapa, orang, Parsa, Chitawan, Rupandehi and Banke) have been identified for comprehensive surveillance because of their high population movements and the open border with ndia as transit points for trade including poultry import. ock Drills to ark the 8 th ational Earthquake Safety Day r. Lekh ath Pokharel inistry of Home ffairs Disaster anagement Section o observe the ational Earthquake safety day in mid January 2006 (2062), the inistry of Home ffairs in cooperation with concerned partners organized a week long program to raise awareness. n this context a simulation exercise was organized focusing on earthquake risk reduction; evacuation and relief activities in Kathmandu aushala area with the active participation of epal Red Cross and Civil Society. n order to assure the public in such panic situations, other activities related to maintaining law and order were also carried out jointly with Royal epal rmy, rmed Police Force, epal Police and other security organizations. o rehearse how to control the situation, mock exercises were launched in different places, and the security personnel were deputed on a massive scale to control the situation immediately. he following four basic objectives were conceptualized to organize the simulation exercise: ssessment of existing capacity. Enable the capacity of related institutions. ssessment of the reality and lesson learning for preparedness. Raise and encourage public awareness for Disaster anagement. he expected outcome of the simulation was to study and experience something that could exist in reality. he exercises were conducted simultaneously and monitored from the control room of the Home inistry. EDCD ctivity Update in February 2006 ational lliance for Canine Rabies Control he Epidemiology and Disease Control Division is facilitating fostering an alliance for Canine Rabies Control. he initiative comprises of four components, which are: 1) female dog sterilization in partnership with Os, 2) vaccination; 3) deworming and; 4) tagging. he interventions will be directed to domestic, communit y and stray dogs. s a part of community awareness raising and social mobilization, there is also a plan for organizing a "dogs' day" on the eve of "Kukur ihar", a festival in ovember he major partner in this initiative will be the Directorate of nimal Health, Department of Livestock Services, inistry of griculture and Cooperatives. Photo: epal Red Cross Society Health ction in epal (onthly Health ews Letter, ssue V, February 2006) Page # 3 of 7

4 [ [ Emergency First id in Conflict ffected Zones Bipin P. Dhakal, RCS ore than 13,000 people have lost their lives in a decade long conflict in the country. his indicates that many more people have been injured and wounded, and many lives could have been saved if there were effective emergency first aid services in the field. epal Red Cross Society (RCS) in cooperation with CRC started Emergency First id services in 2001, with an objective to provide effective field based first aid services particularly to those who are wounded in conflict. n 2005, there were 12 districts (Panchthar, Syangja, Kailali, Dang, Surkeht, Bardiya, Kalikot, Salyan, Pyuthan, Baglung, Sindhuli, Parbat) covered and it has been expanded to additional 10 districts from 2006 (Lamjung, Bajura, ulmi, ugu, Darchula, Bajhang, Ramechhap, lam, Baitadi, yagdi). One hundred and two first aid trainers and 1025 first aid volunteers have been involved in this activity. hese first aid providers have provided first aid service in many incidents where clashes occurred between the warring groups. ccording to Bhoj Raj anni, first aid provider of Kailali district, they provided first aid services to five injured people during clashes. During incidents 10 local trained first aid providers were mobilized to render the first aid services. fter the first aid services had been provided, four injured went back to home and one was transferred to hospital by the volunteers. Similarly, Junior Red Cross members and first aid volunteers became first responders and provided exemplary humanitarian service when a bomb blasted a public bus carrying about 150 passengers in Kalyanpur Village of Chitwan district. "First we raised the legs of the wounded above the heart level and bandaged their wounds tearing own clothes," says an eight grade student mrit ayak, who is treas urer of Hari agar Lower Secondary School, Junior Red Cross Circle. he students recall the bus was shapeless and corpses and wounded bodies were scattered unmanageably in the field. But the lower secondary level students did not lose any sense. We immediately loaded 10 to 12 wounded persons in the carts, tractors and ambulances and sent them to a local health centre", says mrit's friend Ramesh. n addition, RCS volunteers have also provided first aid and humanitarian services in recent incident in aw alparasi district. hese trained first aid workers are committed to render emergency services within the framework of Humanitarian Principles and nternational Humanitarian Law. Emergency First id Services in Kathmandu unicipal elections were held on February 8 and in this connection, a number of scheduled demonstrations and growing political tension caused epal Red Cross Society to establish first aid posts in Kathmandu by from Sunday 5 February. he objective was to provide emergency first aid to injured victims in case of any clashes between security personnel and the demonstrators. he other objective of the RCS first aid post was to provide emergency first aid care to the other victims with injuries. he decisions to establish fieldbased first aid post in such situation was the first of its kind in the capital to give an immediate aid to any people in need. he temporary post was established with a standby Red Cross vehicle and 6 first aid volunteers were deployed. s the team was equipped with necessary skills, standard kits and accessories, it was capable of providing comprehensive emergency first aid that the people might need before reaching hospitals for advanced medical care. epal Red Cross Society plans to extend the emergency aid of this kind in the field to handle the injured victims of any cause. Bipin P. Dhakal of epal Red Cross society says that the first initiative for establishing the field based first post was highly appreciated by people. s a mandate the RCS is committed to expand the initiative within the framework of the humanitarian principles like impartiality and neutrality as a part of its humanitarian work. Health ction in epal (onthly Health ews Letter, ssue V, February 2006) Page # 4 of 7

5 Building Capacity for ational Emergency Preparedness and Response epal is a highly disaster prone country. he range of natural hazards putting epal s 75 districts at risk is impressive both in terms of diversity and scale. Several types of natural hazards like floods, drought, flash floods, glacier lake outburst and landslides are seasonally dependent and may affect different districts at a more or less annual basis with a varying degree of damage to health infrastructure and people s health to follow. o some extent, the occurrence of fires and epidemics also depend on weather and season with a higher occurrence during the dry and wet season respectively. hey may, however, also appear with little or no warning at all as is the case for the other major sudden onset type of disaster, earthquake. For many people, the 1934 reat Bihar Earthquake epitomizes the worst case scenario for epal in the years to come. ajor floods in 1993 as well as in 2002 and 2003 serve as recent reminders of the longterm consequences and developmental implications of disasters. Computer based Earthquake simulations in Dharan n light of the need for an improved level of emergency preparedness, WHO supports the inistry of Health and the Epide miology and Disease Control Division s (EDCD) efforts at enhancing the capacity of the health sector to cope with various types of emergencies. n important aspect of emergency preparedness is to build the capacity of all stakeholders needed for a timely and appropriate response to curative and public health needs of any disaster. BD raining Programs on Emergency Preparedness and Response in the Eastern, Central and Western Regions of epal DRCHUL DO KLL BJH CHH BJUR BRDY HUL KLKO SURKHE BKE JUL DLEKH JJRKO SLY UU D RUKU ROLP SDHU PLCHOK PYU H DOLP RHK HCH KPL BSU B LU YD UL PRB PLP US SYJ KSK WL PRS ass Casualty anagement (C) HU mock drills and / or computer based LJU CHW for edical and other First Responders Public Health in Emergencies for district Rapid Response eams (RR) CH ORKH DHD KW PRS RSUW UWKO KH LL BHK SKHUW SB KVRE SDHUL DHUS D DOLKH R ECHHP SRH UDY KHO SPR BHOJ DH KU OKHL DHU SULUK HUBU RUP DEH DDEL DHUR KCH BR RU H SRLH HO R Computerbased C training in Dharan ERH HU SUSR OR ass Casualty anagement rainings n the period of , the OHP / DHS / EDCD and WHO EH have organized a number of trainings in ass Casualty anagement utilizing live mock drills and computerbased simulations. he objectives were to: 1) expose participants to a simulated health emergency and specifically to the principles of mass casualty management such as disaster logistics, triage, victims' stabilization and medical evacuation and 2) assist hospitals in initiating mass casualty management system in hospitals and also to develop concept for field based casualty management during disasters. he computerbased C simulations utilize software developed by a Danish company and adapted to suit a epali context when purchased by the WHO in pproximately 500 medical first responders have been trained during two rounds of training in Kathmandu. n addition, training was organized in B.P. Koirelia nstitute of Health Sciences in the Eastern town of Dharan targeting participants from a number of health facilities in the region. number of field based C raining programs and mock drills have also been organized in collaboration with various stakeholders. he first pilot training was conducted in the Western city of Pokhara in Kaski District and included participants from Western Regional Hospital, medical college and district hospitals. he second training was conducted in the Southern town of Bharatpur in Chitawan District and included district hospitals, medical colleges and other health facilities from three districts. n Kathmandu, trainings have been organized in Patan hospital and later in Bir Hospital covering a number of government and private hospitals. bout 129 first responders comprising of medical officers, nurses, paramedics, and volunteers from epal Red Cross, epal Scouts, army and police participated in theoretical classes on the principles and approaches of C and were subsequently provided with handson skills through field and hospital based mock drills. n addition, hundreds of volunteers from epal Red Cross, epal Scouts, edical and ursing Education nstitutions, School Children and community people participated as volunteers in the simulation exercises making them an excellent awarenes s raising opportunity for the wider community. o be continued next page PLEJU PCHEHR L JHP Health ction in epal (onthly Health ews Letter, ssue V, February 2006) Page # 5 of 7

6 EDCD ctivity Update in February 2006 Street heatre on alaria and Kalazar From 8 to 26 January 2006, the EDCD team in collaboration with local Os/Clubs (Community Empowerment Centre, Public Service Youth Club and Community Development Project), conducted 50 batches of street drama in Saptari, ahottari and Bara districts of eastern and central regions. he objectives of conducting the street drama were: provide basic information on kalaazar and malaria including causes, sign and symptoms; improve service seeking behaviors and reducing vector breeding places by raising awareness; and mobilize local communities for control and prevention of malaria and kalaazar. ustralian Support to Polio Eradication he ustralian overnment is supporting the WHO programme for Polio eradication in epal with USD 210,000 for the procurement of vaccines. he support is a response to the detection of two new cases of wild poliomyelitis in two districts bordering ndia in With the joint efforts of His ajesty s overnment of epal, WHO, UCEF and other development partners, epal had been poliofree from 2000 to ugust he ustralian financial support will be used to procure vaccines for over 830,000 children under five years of age living in the communities of nin e districts, For the participating hospitals and health institutions, the simulations served to test the functional aspects of existing disaster response plans, as encouragement to develop disaster response plans and as an entry point for first responder institutions to discuss and formulate a fieldbased mass casualty management system. Subsequently, the reference publication Establishing a ass Casualty anagement System published by the Pan merican Health Organisation has been translated to epali and a rainer s manual has been developed detailing the experiences gained in epal. Public Health in Emergencies iven the rugged topography of epal and difficulties of access and logistics management at the best of times, it is imperative to develop local capacities for response. s part of extending emergency preparedness and response activity from the central level to regions and districts, the ohp / DHS / EDCD and WHO EH organized pilot train ing programmes on Public Health in Emergencies for Rapid Response eams in he two training programmes targeted participants from rapid response teams from 12 districts. n both trainings, the participants from health sectors were Senior Pub lic Health Officers from the Regional Health Directorate including District Health Officers, edical Officers, Public Health Officers and other members of district Rapid Response eams. he other participants were members of District Disaster Relief Committees and representatives of epal Red Cross Society (RCS) district chapters. he objective of the trainings was to enhance the basic knowledge of emergency preparedness, disaster response and to provide skills for improved coordination and information management. part from improving networking amongst key stakeholders, the trainings also provided an important opportunity to discuss and initiate the preparation of an emergency preparedness and response plan for the participating districts. ews update in January 2006 Preparation for First Round "ndoor Residual Spray" for alaria and Kalazar Control s a part of the regular vector control programme of the Epidemiology and Disease Control Division, the Logistic anagement Division (LD) dispatched 1510 drums of insecticide (lpha Cypermethrin 5% WP) for indoor residual spraying on 1 February he spraying will be carried out in 21 distric ts for control of alaria and Kalaazar from the beginning of arch o be continued in next page where Subational mmunization Days have already been initiated in the beginning of Health ction in epal (onthly Health ews Letter, ssue V, February 2006) Page # 6 of 7

7 Preparation for First Round "ndoor Residual Spray" Cont. he high priority areas for indoor residual spraying are decided by the district health officer / district public health officer as per set criteria. he priority districts are endemic (lam, Jhapa, orang, Sunsari, Saptari, Siraha, Udayapur, Dhanusha, ahottari, Sindhuli, Chitawan, Sarlahi, Rautahat, Bara, Kavre, Sindhupalchowk, walparasi, Bardiya, Kailali, Kanchanpur and Dadeldhura) for both malaria and kalaazar. Within the endemic districts, the priority areas for malaria control are identified according to the following criteria: 1) villages with high incidence of falciparum malaria; and 2) villages where drug resistant malaria cases are reported; 3) high level of transmission; 4) highly vulnerable areas (resettlement, project areas with mass population movement). First Round ndoor Residual Spray for alaria and Kalazar Control HUL DRCHUL BJH U B BJUR U D KH DU DDE JUL BH LDHUR DO CHH KLKO DOLP K KCH US LL DLEK JJRKO KLL H RUKU SURKHE SLY Y BRDY ROLP D KSK ORKH LJU PRB RSUW BK PYU H E UL D RH SYJ H SDH HCH UWKO K U UPLCHO PLP \ DHD K DOLKH KH KP W LBS RUP BH SULU DEH LPR U S KW K KHUB SKHUW PLEJU CHW LL KVR U PU SB E R OKH DHU PRS SDHU L KHO ERH BR L BHO RU PU HU H SRLH UDYPU J DH R KU H OR R DH L US SRH SPR SUS OR JHP R ndoor Residual Spray BLU Similarly, high priority areas for kalaazar control are: 1) villages with a high incidence rate and 2) settlements where repeatedly kalaazar transmission occurr. he spray teams will be arranged by the local health authorities using the people trained during previous years, and the spray pumps are repaired and maintained locally. he required amount of the insecticide alphacypermethrin 5% WP is calculated on the basis of per capita consumption of 30gm for malaria and 15gm for kalaazar. he insecticid e (100gm) is dissolved in 8 litre water and this suspension is adequate to spray 200sq. m. area. REC H HP P CHE HR Contacts for further information inistry of He alth and Population Dr..B.Bista Department of Health Services Director Epidemiology and Disease EDCD Control Division (EDCD) Department of Health Services eku, Kathmandu, epal el: / Fax: gfatmedcd@gmail.com World Health Organization (WHO) Dr. Kan un WHO Representative World Health Organization U House, P.O. Box 108 Pulchowk, Kathmandu, epal kantun@who.org.np s. rine Ladegaard echnical Officer World Health Organization U House, P.O. Box 108 Pulchowk, Kathmandu, epal ladegaardt@who.org.np Health ction in epal (onthly Health ews Letter, ssue V, February 2006) Page # 7 of 7