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Viewing cable 06RANGOON623, BURMA UNPREPARED TO FIGHT AI IN HUMANS

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Reference ID Created Released Classification Origin
06RANGOON623 2006-05-09 09:37 2011-08-25 00:00 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Rangoon
This record is a partial extract of the original cable. The full text of the original cable is not available.
UNCLAS SECTION 01 OF 02 RANGOON 000623 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
STATE FOR EAP/MLS; PACOM FOR FPA; USDA FOR FAS/PECAD, 
FAS/CNMP, FAS/AAD, APHIS; BANGKOK FOR USAID (JOHN 
MACARTHUR), APHIS 
 
E.O. 12958: N/A 
TAGS: EAGR EAID AMED PGOV PREL CASC TBIO KFLU BM
SUBJECT: BURMA UNPREPARED TO FIGHT AI IN HUMANS 
 
REF: RANGOON 604 
 
1. (SBU) Summary: WHO Country Director Dr. Adik Wibowo 
reported that Australia will donate A$1,000,000 
(approximately $770,000) and the Asia Development Bank plans 
to donate US$1,000,000 to combat AI in Burma, but stressed 
that more work is needed to handle an AI epidemic 
effectively.  On a recent trip to Mandalay Division, WHO 
staff were shocked at how unprepared Burmese medical 
personnel and facilities are to handle surveillance, 
reporting, testing, identification, isolation and treatment 
of AI in humans.  WHO struggles to identify additional 
funding to educate medical specialists, improve lab 
capabilities, and develop rapid response teams.  End summary. 
 
Assistance Trickles In 
---------------------- 
2. (SBU) On May 8, WHO Country Representative Dr. Adik Wibowo 
and Technical Officer Kanokporn Coninx briefed Charge on 
current WHO efforts to combat Avian Influenza (AI) in Burma. 
Wibowo said she had finalized plans for an A$1,000,000 
donation from AusAID, which will be applied to needs 
identified in the March 8, 2006 WHO/FAO Joint Proposal.  The 
Asian Development Bank (ADB) also plans to fund WHO's efforts 
to strengthen Burmese capabilities to fight human AI 
outbreaks.  Wibowo said that the GOB Minister of Health told 
her that he would push the Foreign Economic Resources 
Department (FERD) of the Ministry of Planning to draft a 
letter the ADB requires before it will release the promised 
US$1,000,000.  Although she expressed gratitude for this new 
funding, and past and potential USG contributions, Wibowo 
said, "it is only a grain of sand in a desert full of need." 
 
Transparency and Cooperation 
---------------------------- 
3. (SBU) Wibowo informed Charge that a Thai epidemiologist 
had just joined Rangoon FAO staff for two months, and that 
she also plans to hire a local epidemiologist for the WHO 
office.  She is seeking an international epidemiologist to be 
assigned to her office.  WHO, FAO, UNICEF, and Ministry of 
Health officials on a Risk Committee have developed 
communication materials for dissemination in both affected 
and non-affected areas.  "That cooperation has been called a 
model for the region," she said.  Both Wibowo and Coninx 
repeatedly emphasized the good cooperation they had received 
from the Minster down to local health officials.  Officials 
at every level have been completely transparent in sharing 
all information gathered to date. 
 
Team Identifies Priorities 
-------------------------- 
4. (SBU) Coninx briefed Charge on her recent trip to Mandalay 
Division with three epidemiologists from WHO Bangkok, 
including the head of the Thai CDC office.  The team had 
specific approval from the Minister to visit medical 
facilities at the district, township and village levels, 
including Kandawnadi Hospital, the Mandalay facility 
designated to receive human AI patients from northern and 
central Burma.  She was "shocked by how unprepared" the 
facility and the staff are.  Kandawnadi is an old orthopedic 
hospital closed in 2000, reopened during the SARS epidemic in 
2003, closed again, and recently reopened to handle AI.  One 
doctor, one nurse, and two workers come in for daily shifts, 
but they have no equipment or supplies, including basics such 
as IV drip holders.  The ability to isolate patients is 
nonexistent, so medical staff would be at risk when treating 
AI patients.  No biosafety measures have been implemented. 
Coninx also noted that, despite Health Ministry claims, 
medical personnel had received no training on identifying and 
handling suspected AI cases.  At the village level, midwives 
with no medical training have been given responsibility for 
preparing the weekly and monthly AI status reports that are 
sent to the Ministry of Health. 
 
5. (SBU) The WHO visiting team identified the following 
priority activities to improve the GOB's ability to address 
human cases of AI: 
 
-- Sponsor a study tour by Burmese state/division directors 
to medical facilities in Thailand to expose them to current 
standards and procedures.  Wibowo said that the Thai Minister 
of Public Health told her recently that he would help fund 
WHO efforts to train Burmese health professionals to fight 
AI.  Wibowo noted that two Burmese health officials attended 
lab training recently in Bangkok, and she hoped to send more 
for lab training in June and for AI preparedness training in 
August. 
 
-- Upon the participants' return from Thailand, begin to 
train medical personnel from the state/division level down to 
the village level. 
 
-- Once health care workers are trained, establish rapid 
response teams in each township, comprised of a doctor, a 
nurse, two lab technicians and one support staff person. 
 
-- Prepare two to three proper isolation units in each of the 
two hospitals designated to accept potential AI patients. 
 
-- Improve lab capabilities.  Wibowo noted that, due to the 
antiquated equipment found at division levels, it would be 
more cost effective to rely on a central lab.  This would 
require development of a safe system to transport samples to 
Rangoon from the rest of the country.  Currently health 
officials hand-carry them to Rangoon. 
 
-- Develop a better case definition of potential AI in 
humans.  Burmese medical authorities lack up-to-date 
information based on recent studies in Thailand and Vietnam, 
Wibowo said.  Specifically, they need to look at cases of 
severe pneumonia more closely.  Currently, doctors are 
monitoring four patients in Mandalay Division and four 
patients in Sagaing Division for AI.  "We have a golden 
opportunity to improve their capability now," Wibowo said, 
"before there is an actual human case here." 
 
6. (SBU) Comment: GOB health officials realize how unprepared 
they are to cope with a human AI pandemic.  They have been 
given the responsibility, but no resources, thus their 
eagerness to cooperate with the international community.  Dr. 
Wibowo has set the tone for engagement that has allowed, and 
encouraged, GOB officials to share information with the 
international community.  She understands both donor 
sensitivities and the woeful state of GOB capabilities.  A 
U.S. epidemiologist working with WHO, and USG assistance in 
support of the WHO/FAO Joint Proposal, would enable us to 
guide preparations at an early stage to contain and control 
the spread of AI well before it spreads to our shores.  This 
is an area where Burma has already indicated that our advice 
will be welcomed.  We should take up the opportunity.  End 
comment. 
VILLAROSA