The COVID-19 pandemic in the ASEAN: A preliminary report on the spread, burden and medical capacities

Objective: To provide preliminary descriptions of the spread, burden and related medical capacity characteristics of the ASEAN countries. Methods: We utilized the data from four main official databases, including WHO reports, the Statistics and Research of the Coronavirus Disease, and the Southeast Asia Program of the Center for Strategic and International Study. The spread of the COVID- 19 pandemic, current burden and the COVID-19 medical response capacities were extracted before April 11, 2020. Results: As of April 13, 2020, the ASEAN countries reported 19 547 COVID-19 positive cases with 817 deaths (case-facility rate of 4.2%). Thailand was the first country in the region that reported having the COVID-19 cases, while Laos was the last to report confirmed COVID-19 cases. Durations for the number of deaths to double were between 8-12 days. For the testing and treatment capacities, the number of PCR tests provided to the populations was the highest in Vietnam, followed by Singapore, Malaysia, and Thailand. Meanwhile, the percentage of the population being tested was the highest in Brunei (2.31%), followed by Singapore (1.30%). Conclusions: A wide range of interventions were taken into practice in response to the outbreak with an effort of curbing the rise of this pandemic. However, special care should not be overlooked as the pandemic is placing a huge impact on the population and becomes increasingly unpredictable. To tackle the spread of the pandemic in the region, the ASEAN countries should work together as one community to provide better responses to future pandemics and other transboundary public health challenges.

The COVID-19 pandemic in the ASEAN: A preliminary report on the spread, burden and medical capacities

Objective: To provide preliminary descriptions of the spread, burden and related medical capacity characteristics of the ASEAN countries. Methods: We utilized the data from four main official databases, including WHO reports, the Statistics and Research of the Coronavirus Disease, and the Southeast Asia Program of the Center for Strategic and International Study. The spread of the COVID- 19 pandemic, current burden and the COVID-19 medical response capacities were extracted before April 11, 2020. Results: As of April 13, 2020, the ASEAN countries reported 19 547 COVID-19 positive cases with 817 deaths (case-facility rate of 4.2%). Thailand was the first country in the region that reported having the COVID-19 cases, while Laos was the last to report confirmed COVID-19 cases. Durations for the number of deaths to double were between 8-12 days. For the testing and treatment capacities, the number of PCR tests provided to the populations was the highest in Vietnam, followed by Singapore, Malaysia, and Thailand. Meanwhile, the percentage of the population being tested was the highest in Brunei (2.31%), followed by Singapore (1.30%). Conclusions: A wide range of interventions were taken into practice in response to the outbreak with an effort of curbing the rise of this pandemic. However, special care should not be overlooked as the pandemic is placing a huge impact on the population and becomes increasingly unpredictable. To tackle the spread of the pandemic in the region, the ASEAN countries should work together as one community to provide better responses to future pandemics and other transboundary public health challenges.

An Electronic Questionnaire Survey Evaluating the Perceived Prevalence and Practices of Lactose Intolerance in 1 to 5 Year Old Children in South East Asia / 대한소아소화기영양학회지

PURPOSE: Lactose intolerance (LI) is perceived to be frequent in Asia and has been reported to have considerable impact on dietary intake, nutritional status and the quality of life. We aimed to gather information from healthcare professionals on the perceived incidence, diagnosis and management of LI in 1 to 5 year old children in Southeast Asia. METHODS: An anonymous electronic survey was sent randomly among healthcare professionals registered in the database of the pediatric societies in Thailand, Indonesia, and Singapore between June and October 2016. RESULTS: In total, 259 health care professionals responded of which 45.5% (n=118) were from Thailand, 37.4% (n=97) from Indonesia and 16.9% (n=44) from Singapore. Of the participants who responded (n=248), primary LI prevalence among children 1 to 3 years of age was estimated to be less than 5% by 56.8%. However, about 18.9% (n=47) answered they did not know/unsure. Regarding secondary LI, 61.6% of respondents (n=153) estimated the prevalence to be less than 15%. But again, 10.8% (n=27) answered they did not know or unsure. Rotavirus gastroenteritis was ranked as the top cause for secondary LI. There was considerable heterogeneity in the diagnostic methods used. The majority of respondents (75%) recommended lactose-free milk to manage primary and secondary LI. CONCLUSION: More education/training of pediatricians on this topic and further epidemiological studies using a more systematic approach are required.

Melioidosis en paciente del sudeste asiático / Melioidosis in a Southeast Asian patient

La melioidosis es una enfermedad infecciosa causada por una bacteria gram-negativa intracelular facultativa, Burkholderia pseudomallei, que se encuentra en el suelo y el agua. Es de importancia para la salud pública en las zonas endémicas, sobre todo el sudeste asiático. Se han descrito casos fuera de las regiones endémicas en su mayoría adquiridos por los visitantes a estas áreas. Se presenta el caso de un paciente masculino con sintomatología respiratoria, elementos de sepsis y contracción volumétrica, en el que se diagnosticó diabetes mellitus de debut, neumonía adquirida en la comunidad y finalmente se aisló en hemocultivo la Burkholderia pseudomallei. Se comenzó tratamiento recomendado acorde al antibiograma, observándose evolución satisfactoria del paciente(AU)

Melioidosis is an infectious disease caused by a facultative intracellular gram-negative bacterium, Burkholderia pseudomallei, found in soil and water. It is of importance for public health in endemic areas, especially Southeast Asia. Cases have been described outside the endemic regions, mostly acquired by visitors to these areas. The case is presented of a male patient with respiratory symptoms, elements of sepsis and volumetric contraction, in which the diagnosis of onset diabetes mellitus and community-acquired pneumonia, while Burkholderia pseudomallei was finally isolated in hemoculture. The recommended treatment was started according to the antibiogram, observing the patient's satisfactory evolution(AU)

Adverse effects on health posed by consumption of Areca nut (Areca catechu L., family: Palmaceae).

This review paper discusses the impact of areca nut (Betel nut) on human health. Small pieces of betel nut are generally use with betel leaf after meals in a day or on any festival. Areca nut seed contains bioactive components like alkaloids and tannins. It is known as salivary stimulating, digestive agents and act as antimicrobial effect against oral bacteria. Along with the few beneficial effects, it has some adverse effects on the human body. Need to enhance the awareness activities regarding the health concern due to consumption of areca nut.

National nursing and midwifery legislation in countries of South-East Asia with high HIV burdens.

This paper analyses nursing and midwifery legislation in high HIV-burden countries of the World Health Organization (WHO) South-East Asia Region, with respect to global standards, and suggests areas that could be further examined to strengthen the nursing and midwifery professions and HIV service delivery. To provide universal access to HIV/AIDS prevention, care and treatment, sufficient numbers of competent human resources for health are required. Competence in this context means possession and use of requisite knowledge and skills to fulfil the role delineated in scopes of practice. Traditionally, the purpose of professional regulation has been to set standards that ensure the competence of practising health workers, such as nurses and midwives. One particularly powerful form of professional regulation is assessed here: national legislation in the form of nursing and midwifery acts. Five countries of the WHO South-East Asia Region account for more than 99% of the region’s HIV burden: India, Indonesia, Myanmar, Nepal and Thailand. Online legislative archives were searched to obtain the most recent national nursing and midwifery legislation from these five countries. Indonesia was the only country included in this review without a national nursing and midwifery act. The national nursing and midwifery acts of India, Myanmar, Nepal and Thailand were all fairly comprehensive, containing between 15 and 20 of the 21 elements in the International Council of Nurses Model Nursing Act. Legislation in Myanmar and Thailand partially delineates nursing scopes of practice, thereby providing greater clarity concerning professional expectations. Continuing education was the only element not included in any of these four countries’ legislation. Countries without a nursing and midwifery act may consider developing one, in order to facilitate professional regulation of training and practice. Countries considering reform to their existing nursing acts may benefit from comparing their legislation with that of other similarly situated countries and with global standards. Countries interested in improving the sustainability of scale-up for HIV services may benefit from a greater understanding of the manner in which nursing and midwifery is regulated, be it through continuing education, scopes of practice or other relevant requirements for training, registration and licensing.

Love and sexual relationships in a globalized world / Relacionamentos amorosos e sexuais em um mundo globalizado / Rapports amoureux et sexuels dans un monde globalisé / Relacionamientos amorosos y sexuales en un mundo globalizado

With the development of globalized exchanges, sexual and/or sentimental relationships between developed and developing countries are becoming more and more frequent. Through the comparative study of relationships between Occidental and Thai or Malay people, we will see how Occidental and Oriental actors use hierarchies of gender, class and race to try to valorise their economic, cultural, social and symbolic capital. In Thailand, lower-class women seek access to financial stability while in the neighbouring country, upper-class women aspire to freedom from local culture. For Occidental men, what hides behind their desire of the “other” is a rejection of "Occidental values", especially sexual equality, and a return to values considered more "stable", "traditional", and "hierarchical". We will see how love interactions in a globalized context are an instrument to valorise the different forms of capital, in Bourdieu‟s sense, and a way to redefine social hierarchies.

Com o desenvolvimento dos intercâmbios globalizados, as interações sexuais e/ou amorosas entre os países desenvolvidos e em desenvolvimento se tornaram mais frequentes. Por meio de um estudo comparativo das relações entre Ocidentais e Tailandeses e Malaios, veremos como sujeitos Ocidentais e Orientais usam as hierarquias de gênero, classe e raça para valorizar seus capitais econômico, cultural, social e simbólico. Se na Tailândia, as mulheres oriundas das classes desfavorecidas buscam uma certa segurança financeira, no país vizinho, as mulheres das classes abastadas desejam a liberdade em relação à cultura local. Para os homens ocidentais, o desejo pelo "outro" esconde uma rejeição dos "valores ocidentais", particularmente a igualdade entre os sexos, e o desejo de retomar valores considerados mais "estáveis", "tradicionais" e "hierárquicos". Nós veremos como as interações amorosas globalizadas valorizam diferentes formas de capital, no sentido de Bourdieu, redefinindo hierarquias sociais.

Avec le développement des échanges mondialisés, les interactions sexuelles et/ou amoureuses entre les pays développés et en développement deviennent plus fréquentes. A travers l‟étude comparative des relations entre Occidentaux et Thaïlandais ou Malaisiens nous verrons comment, par le biais des hiérarchies de genre, de classe et de "race", les acteurs occidentaux et orientaux tentent de revaloriser leur capital économique, culturel, social et symbolique. Si en Thaïlande les femmes issues des classes défavorisées peuvent espérer une certaine assurance financière, dans le pays voisin les femmes d'un milieu aisé souhaitent accéder à davantage de liberté face à l'emprise de la culture locale. Ce désir de l'autre cache souvent chez les Occidentaux un rejet des dites "valeurs occidentales", notamment l'égalité des sexes, et une volonté de retour vers des valeurs considérées "stables", "traditionnelles" et "hiérarchisées".

Con el desarrollo de los intercambios globalizados, las interacciones sexuales y/o amorosas entre el Occidente y los países en desarrollo se tornan más frecuentes. Por medio de los estudios comparativos de las relaciones entre Occidentales y Tailandesas o Malayas vemos como, por la perspectiva de las jerarquías de genero, de clase y de “raza”, lo actores occidentales y orientales tienden a valorar sus capitales económicos, culturales, sociales y simbólicos. Si en Tailandia las mujeres oriundas de las clases desfavorecidas pueden esperar una cierta seguridad financiera, en el país vecino, las mujeres de las clases abastadas desean el acceso a la libertad frente a la cultura y de la religión locales. Este deseo por el otro esconde, frecuentemente, por parte de los Occidentales un rechazo de los dichos “valores occidentales”, particularmente a la igualdad entre los sexos, y una voluntad de retornar a valores considerados más “estables”, “tradicionales” y "jerárquicos”. Vemos así como las interacciones amorosas globalizadas son un instrumento de valorización de diferentes maneras de capital, no sentido de Bourdieu, y una manera de redefinir las jerarquías sociales.

Levels and trends of smokeless tobacco use among youth in countries of the World Health Organization South-East Asia Region.

BACKGROUND: At least two rounds of the Global Youth Tobacco Survey (GYTS) have been completed in most of the countries in the World Health Organization South‑East Asia region. Comparing findings from these two rounds provides trend data on smokeless tobacco (SLT) use for the first time. METHODS: This study uses GYTS data from Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor‑Leste during 2006–2013. GYTS is a nationally representative survey of 13–15‑year‑old students using a consistent and standard protocol. Current SLT use is defined as using any kind of SLT products, such as chewing betel quid or nonbetel quid or snuffing any other products orally or through the nasal route, during the 30 days preceding the survey. Prevalence and 95% confidence intervals were computed using SAS/SUDAAN software. RESULTS: According to most recent GYTS data available in each country, the prevalence of current use of SLT among youth varied from 5.7% in Thailand to 23.2% in Bhutan; among boys, from 7.1% in Bangladesh to 27.2% in Bhutan; and among girls, from 3.7% in Bangladesh to 19.8% in Bhutan. Prevalence of SLT was reported significantly higher among boys than girls in Bhutan (boys 27.2%; girls 19.8%), India (boys 11.1%; girls 6.0%), Maldives (boys 9.2%; girls 2.9%), Myanmar (boys 15.2%; girls 4.0%), and Sri Lanka (boys 13.0%; girls 4.1%). Prevalence of current SLT use increased in Bhutan from 9.4% in 2009 to 23.2% in 2013, and in Nepal from 6.1% in 2007 to 16.2% in 2011. CONCLUSION: The findings call for countries to implement corrective measures through strengthened policy and enforcement.

Prevalence and sociodemographic determinants of tobacco use in four countries of the World Health Organization: South-East Asia region: Findings from the Global Adult Tobacco Survey.

INTRODUCTION: Tobacco use is a leading cause of deaths and Disability Adjusted Life Years lost worldwide, particularly in South‑East Asia. Health risks associated with exclusive use of one form of tobacco alone has a different health risk profile when compared to dual use. In order to tease out specific profiles of mutually exclusive categories of tobacco use, we carried out this analysis. METHODS: The Global Adult Tobacco Survey (GATS) data was used to describe the profiles of three mutually exclusive tobacco use categories (“Current smoking only,” “Current smokeless tobacco [SLT] use only,” and “Dual use”) in four World Health Organization South‑East Asia Region countries, namely Bangladesh, India, Indonesia and Thailand. GATS was a nationally representative household‑based survey that used a stratified multistage cluster sampling design proportional to population size. Prevalence of different forms of usage were described as proportions. Logistics regression analyses was performed to calculate odds ratios (OR) with 95% confidence intervals. All analyses were weighted, accounted for the complex sampling design and conducted using SPSS version 18. RESULTS: The prevalence of different forms of tobacco use varied across countries. Current tobacco use ranged from 27.2% in Thailand to 43.3% in Bangladesh. Exclusively smoking was more common in Indonesia (34.0%) and Thailand (23.4%) and less common in Bangladesh (16.1%) and India (8.7%). Exclusively using SLT was more common in Bangladesh (20.3%) and India (20.6%) and less common on Indonesia (0.9%) and Thailand (3.5%). Dual use of smoking and SLT was found in Bangladesh (6.8%) and India (5.3%), but was negligible in Indonesia (0.8) and Thailand (0.4%). Gender, age, education and wealth had significant effects on the OR for most forms of tobacco use across all four countries with the exceptions of SLT use in Indonesia and dual use in both Indonesia and Thailand. In general, the different forms of tobacco use increased among males and with increasing age; and decreased with higher education and wealth. The results for urban versus rural residence were mixed and frequently not significant once controlling for the other demographic factors. CONCLUSION: This study addressed the socioeconomic disparities, which underlie health inequities due to tobacco use. Tobacco control activities in these countries should take in account local cultural, social and demographic factors for successful implementation.

Health spending, macroeconomics and fiscal space in countries of the World Health Organization South-East Asia Region.

The paper examines the issues around mobilization of resources for the 11 countries of the South-East Asia Region of the World Health Organization (WHO), by analysing their macroeconomic situation, health spending, fiscal space and other determinants of health. With the exception of a few, most of these countries have made fair progress on their own Millennium Development Goal (MDG) targets of maternal mortality ratio and mortality rate in children aged under 5 years. However, the achieved targets have been very modest – with the exception of Thailand and Sri Lanka – indicating the continued need for additional efforts to improve these indicators. The paper discusses the need for investment, by looking at evidence on economic growth, the availability of fiscal space, and improvements in “macroeconomic-plus” factors like poverty, female literacy, governance and efficiency of the health sector. The analysis indicates that, overall, the countries of the WHO South-East Asia Region are collectively in a position to make the transition from low public spending to moderate or even high health spending, which is required, in turn, for transition from lowcoverage–high out-of-pocket spending (OOPS) to highcoverage–low OOPS. However, explicit prioritization for health within the overall government budget for low spenders would require political will and champions who can argue the case of the health sector. Additional innovative avenues of raising resources, such as earmarked taxes or a health levy can be considered in countries with good macroeconomic fundamentals. With the exception of Thailand, this is applicable for all the countries of the region. However, countries with adverse macroeconomic-plus factors, as well as inefficient health systems, need to be alert to the possibility of overinvesting – and thereby wasting – resources for modest health gains, making the challenge of increasing health sector spending alongside competing demands for spending on other areas of the social sector difficult.

The application of social impact bonds to universal health-care initiatives in South-East Asia.

Social impact bonds (SIBs) have the potential to improve the efficiency of government health-care spending in South-East Asia. In a SIB, governments sign a pay-for-performance contract with one or several providers of health-care services, and the providers borrow up-front capital from investors. Governments outside South-East Asia have started to experiment with SIBs in criminal justice, homelessness and health care. Governments of South-East Asia can advance the goal of universal health care by using SIBs to improve the efficiency of healthcare service providers and by motivating providers to expand coverage. This paper describes SIBs and their potential application to health-care initiatives in the Region.

Malaria elimination in Sri Lanka: what it would take to reach the goal.

Fifty years after narrowly missing the opportunity to eliminate malaria from Sri Lanka in the 1960s, the country has now interrupted malaria transmission and sustained this interruption for more than 12 months – no indigenous malaria cases have been reported since October 2012. This was achieved through a period overlapping with a 30-year separatist war in areas that were endemic for malaria. The challenge now, of sustaining a malaria-free country and preventing the reintroduction of malaria to Sri Lanka, is examined here in the context of rapid postwar developments in the country. Increased travel to and from the country to expand development projects, businesses and a booming tourist industry, and the influx of labour and refugees from neighbouring malarious countries combine with the continued presence of malaria vectors in formerly endemic areas, to make the country both receptive and vulnerable to the reintroduction of malaria. The absence of indigenous malaria has led to a loss of awareness among the medical profession, resulting in delayed diagnosis of malaria despite the availability of an extensive malaria diagnosis service. Highly prevalent vector-borne diseases such as dengue are competing for health-service resources. Interventions that are necessary at this critical time include sustaining a state-of-the-art surveillance and response system for malaria, and advocacy to maintain awareness among the medical profession and at high levels of government, sustained funding for the Anti-Malaria Campaign and for implementation research and technical guidance on elimination. The malaria-elimination effort should be supported by rigorous analyses to demonstrate the clear economic and health benefits of eliminating malaria, which exceed the cost of a surveillance and response system. An annual World Health Organization review of the programme may also be required.

Chronic disease management in the South‑East Asia Region: a need to do more.

Chronic diseases account for a substantial proportion of deaths in the South‑East Asia Region, ranging from 34% in Timor‑Leste to 79% in Maldives. Fuelled by the epidemiological shift towards noncommunicable diseases, the burden of chronic conditions is steadily increasing. Care structures for chronic diseases in most of these countries focus only on certain conditions and are often oriented towards episodic illnesses. An opportunity exists for holistic, country‑driven applications of the World Health Organization Innovative Care for Chronic Conditions framework to improve quality of care for chronic conditions in the region.

Changing epidemiology of dengue in South-East Asia.

The burden of dengue and its potential threat to global health are now globally recognized, with 2.5 billion people at risk worldwide. The pathogenesis of severe dengue is particularly intriguing with the involvement of different immune factors. Also, the epidemiology of dengue in South-East Asia is undergoing a change in the human host, the dengue virus and the vector bionomics. Shift in affected age groups, sex differences and expansion to rural areas are evident, while the virulence and genotype of the virus determine the severity and time interval between sequential infections. The Aedes mosquito, a potent and adaptive vector, has evolved in longevity and survival, affected by seasonality and climate variability, socio-cultural and economic factors of human habitation and development. This review provides insights into the changing epidemiology and its factors in South-East Asia, one of the most important epicentres of dengue in the world, highlighting the major factors influencing these rapid changes. Addressing the changes may help mitigate the challenges in the current dengue control and prevention efforts.

Best practices in tobacco control in the South-East Asia Region.

The tobacco epidemic is an increasing threat to public health with the tobacco burden particularly high in WHO's South-East Asia Region (SEAR). The Region has many obstacles to tobacco control, but despite these challenges, significant progress has been made in many countries. Although much work still needs to be done, SEAR countries have nevertheless implemented strong and often innovative tobacco control measures that can be classified as "best practices," with some setting global precedents. The best practice measures implemented in SEAR include bans on gutka, reducing tobacco imagery in movies, and warning about the dangers of tobacco. In a time of scarce resources, countries in SEAR and elsewhere must ensure that the most effective and cost-efficient measures are implemented. It is hoped that countries can learn from these examples and as appropriate, adapt these measures to their own specific cultural, social and political realities.

Progress in health-related millennium development goals in the WHO South-East Asia Region.

Home to 25% of the world's population and bearing 30% of the Global disease burden, the South-East Asia Region [1] of the World Health Organization has an important role in the progress of global health. Three of the eight million development goal (MDG) goals that relate to health are MDG 4, 5, and 6. There is progress in all three goals within the countries of the region, although the progress varies across countries and even within countries. With concerted and accelerated efforts in some countries and certain specific areas, the region will achieve the targets of the three health MDGs. The key challenges are in sustainable scaling up of evidence-based interventions to improve maternal and child health and controlling communicable diseases. This will require continued focus and investments in strengthening health systems that provide individual and family centered comprehensive package of interventions with equitable reach and that which is provided free at the point of service delivery. Important lessons that have been learnt in implementing the MDG agenda in the past two decades will inform setting up of the post MDG global health agenda. This article provides a snap shot of progress thus far, key challenges and opportunities in WHO South-East Asia Region and lays down the way forward for the global health agenda post 2015.

Second-hand Smoke: A neglected public health challenge.

Exposure to secondhand smoke (SHS) causes an estimated 5% of the global burden of disease, slightly higher than the burden from direct use of tobacco. This review highlights the urgent need to address this ignored public health issue by presenting the evidence and impact of SHS on those exposed using global studies including those from the South-East Asia Region. The burden of morbidity from SHS exposure is higher in low-income countries in Southeast Asia region compared to the rest of the world. SHS exposure affects those most vulnerable, especially women and children. While several countries in the region have enacted legislation which offer protection to those exposed to SHS, most measures are partial and inadequate. As a result, implementation and compliance at national and sub-national level within the countries of the Southeast Asia region is variable. Governments must ensure that legislation mandates comprehensive smoke-free environments in order to provide public health benefit which offers universal protection to everyone and everywhere. Where comprehensive legislation exists, stringent implementation and enforcement, along with awareness building, education and monitoring through regular compliance studies must be done to sustain smokefree status of public places within jurisdictions.

Medical Education in south east Asia Current trend and Malaysia's perspective.

After the concept of evidence based medicine it became important all over the world to have more structured, clinical oriented curriculum. According to the United Nations, Asia is divided into five sub regions. Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam belong to South-eastern Asia. To cope with the rapid changes in medical education curriculum most of the medical school in Asia particularly south East Asian countries adopted took up curriculum to fit to the current need. Medical education in Malaysia and Singapore developed similarly as the two countries together formed a federation in the British Empire until independence in 1957. Currently, in medical education, a trend has emerged to utilize "trustable research findings" in place of "personal opinions" as a basis for educational management and decision-making. Several of Malaysia's medical schools partner with other European, American and Asian schools, and students sometimes earn the certification or accreditation to practice in those countries as well. In the context of changing medical education system, South East Asia is also adopting up to date medical curriculum for the medical students in these countries. As a result rapid changes in curriculum with special focus on research these schools likely to become a hub of 'educational tourist'.

Education and training of medical physicists in South East Asia: accomplishments and challenges

John Cameron has made significant contributions to the field of Medical Physics. His contributions encompassed research and development, technical developments and education. He had a particular interest in the education of medical physicists in developing countries. Structured clinical training is also an essential component of the professional development of a medical physicist. This paper considers aspects of the clinical training and education of medical physicists in South-East Asia and the challenges facing the profession in the region if it is to keep pace with the rapid increase in the amount and technical complexity of medical physics infrastructure in the region.

Contibuições multifacetadas: trabalhadores da saúde e a erradicação da varíola na Índia / Multifaceted contributions: health workers and smallpox eradication in India

A erradicação da varíola no Sul da Ásia resultou dos múltiplos esforços de trabalhadores da saúde de vários níveis. Trabalhando a partir do interior de organizações internacionais e estruturas governamentais, o papel dos funcionários de campo, originários de várias nacionalidades e também provenientes de cidades e enclaves rurais dos países dessas regiões, foi crucial para o desenvolvimento e a distribuição de planos de ação. Entretanto, o papel desses funcionários é geralmente minimizado em histórias oficiais e acadêmicas que ressaltam, ao invés, os papéis desempenhados por um reduzido número de funcionários seniores dentro da Organização Mundial da Saúde e dos governos federais do subcontinente. Este artigo busca oferecer uma avaliação mais integral da complexa situação da erradicação da varíola. Nesse sentido, faz-se um esforço para sublinhar a grande utilidade da flexibilidade operacional apresentada pelos funcionários de campo, na qual as lições aprendidas no trabalho de campo tornaram-se parte integrante da distribuição de campanhas locais. Uma importante característica foi o cuidadoso engajamento com as comunidades-alvo, bem como a contratação por curtos períodos de pessoal dessas mesmas comunidades.

Smallpox eradication in South Asia was a result of the efforts of many grades of health-workers. Working from within the confines of international organisations and government structures, the role of the field officials, who were of various nationalities and also drawn from the cities and rural enclaves of the countries in these regions, was crucial to the development and deployment of policies. However, the role of these personnel is often downplayed in official histories and academic histories, which highlight instead the roles played by a handful of senior officials within the World Health Organization and the federal governments in the sub-continent. This article attempts to provide a more rounded assessment of the complex situation in the field. In this regard, an effort is made to underline the great usefulness of the operational flexibility displayed by field officers, wherein lessons learnt in the field were made an integral part of deploying local campaigns; careful engagement with the communities being targeted, as well as the employment of short term workers from amongst them, was an important feature of this work.