BURMA UNPREPARED TO FIGHT AI IN HUMANS

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