Indonesia - Indonesia rejects U.S. research estimate of 100,000 'haze' deaths

An aerial view of a forest fire burning near the village of Bokor, Meranti Islands regency, Riau province, Sumatra, Indonesia in this March 15, 2016 file photo taken by Antara Foto. REUTERS/ Rony Muharrman/Antara Foto/Files

Harvard and Columbia university research showing smoke from land fires in Southeast Asia led to more than 100,000 premature deaths last year "makes no sense at all," an official at Indonesia's Health Ministry said on Tuesday.

Indonesian government records show only 24 deaths related to forest fires in 2015, but the disaster was estimated to have left more than half a million Indonesians suffering from respiratory ailments.

Indonesia is under global pressure to put an end to slash-and-burn land clearances for palm and pulp plantations which send clouds of toxic smoke over the region each year.

The university research estimates pollution exposure from last year's fires killed 91,600 people in Indonesia, 6,500 in Malaysia and 2,200 in Singapore in 2015 and 2016, significantly higher than government records.

"Given the severe haze in Equatorial Asia in 2015, the 100,000 premature deaths in that region are not so surprising," said Loretta Mickley, a senior researcher at Harvard focusing on atmospheric pollution, who contributed to the research.

Health Ministry director general of disease prevention and control Mohamad Subuh told Reuters the research data was wrong.

"Data on deaths is clear. We have surveillance," Subuh said, adding that the assumptions of mortality based on mathematical calculations were "irresponsible".

Every year, Indonesia faces criticism from its neighbors Singapore and Malaysia over the smog, euphemistically known as "haze", and its failure to stop the fires from being lit.

Last year's fires were among the worst in the region's history, with billions of dollars worth of environmental damage, weeks of flight and school disruptions and thousands suffering from respiratory disease.

(This story corrects dateline and day of attribution in the lede.)

(Editing by Nick Macfie)

Fergus Jensen and Bernadette Christina Munthe 

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Indonesia - Govt woos specialists to work in regions

Bracing for a stream of foreign medical professionals entering the country after the implementation of the ASEAN Economic Community (AEC), the government is devising a set of incentives to encourage local specialists to work in the regions.

The Health Ministry hopes the incentives will lure surgeons, pediatricians, internists, obstetricians and anesthetists to areas in short supply of specialists for at least a year.

The plan also aims to keep local specialists competitive compared to the foreign doctors that will soon be allowed to move freely between countries in Southeast Asia.

The ministry’s Director General of Community Services, Bambang Wibowo, when opening the Indonesian Medical Council (KKI) national coordination meeting in Surabaya, East Java, said foreign doctors would make efforts to take over regions in Indonesia that have a shortage of doctors.

“The number of specialists is very limited in those regions, especially in the eastern part of Indonesia as well as in border regions and on islands. This requires awareness of the doctors that they are needed there,” said Bambang Wibowo in Surabaya on Tuesday.

Indonesia, according to Bambang, has become a lucrative market for players in the health service. Doctors are still in short supply at many of the country’s 9,754 community health centers (Puskesmas) and 2,573 hospitals. Moreover, the population of Indonesia is estimated to reach 270 million people in 2020, which would include a significant number of middle-income earners able to afford private health care.

The policy to assign specialists to areas that lack doctors for at least a year is backed up by an existing program to assign teams of newly-graduated physicians, dentists, midwives and health analysts to remote areas in a bid to cover the shortage of doctors in Indonesia.

Based on KKI data, Indonesia currently has 175,410 registered doctors, 31,414 of whom are specialists.

KKI chairman Bambang Supriyatno said synergy between all stakeholders was needed to address the issue.

“This month, we will discuss domestic regulations in response to the potential and threat of the influx of foreign doctors to Indonesia,” said Bambang.

At the same occasion, University of Defense professor Rear Admiral (ret.) Setyo Harnowo said Indonesia faced no obvious military threats from outside in the next 10 years, but it faced non-military ones instead.

“Indonesia is facing the threat of a proxy war, or a weakening of the nation using non-military means, such as economic and health threats, and the health threats must be faced by those in the health sector,” said Setyo.

Separately, House of Representatives Commission IX chairman Dede Yusuf Macan Effendi, who also spoke at the forum, said he was encouraging the Health Ministry and KKI to maintain an equal distribution of doctors across Indonesia.

The Democratic Party politician related his experience in meeting with the regent of Membramo in Papua, who he said was willing to provide Rp 50 million as “settling-down” cash, aside from regular income and other facilities, to specialists willing to serve in the regency.

“Seeing that the administration is willing to give Rp 50 million, imagine the desire of the regency to have specialists there,” said Dede.

Dede urged KKI to encourage the presence of medical schools in regions with a shortage of doctors, because doctors generally gathered in campuses with medical schools.

Wahyoe Boediwardhana

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Cambodia - Health Ministry insists system ‘ready’ for Zika

An official with the Ministry of Health, responding to a Pasteur Institute analysis that indicated the Kingdom is at high risk of a Zika outbreak in 2017, yesterday said Cambodia’s health service teams were ready to respond.

Ministry spokesman Ly Sovann said Cambodia is employing an existing multi-source surveillance system that includes scanners at airports and key border checkpoints to detect Zika early on. Hospitals across the country have also been ordered to report any suspected cases.

“Our public health measures are in place to respond to an outbreak,” said Sovann, also the director of the ministry’s Department of Communicable Diseases. “We are ready to respond, in collaboration with Pasteur, the World Health Organization, [the US Centers for Disease Control] and other partners.”

The Pasteur Institute’s brief analysis, authored by researchers Dr Didier Fontenille and Dr Philippe Dussart, was posted on its website on October 19.

The Kingdom saw seven Zika cases from 2007 to 2010, but no recent cases have been reported, despite cases cropping up in Vietnam, Thailand and elsewhere in the region.

Multiple attempts to get Fontenille and Dussart to provide the basis for their conclusions over the last two days were unsuccessful.

Sovann, meanwhile, said he couldn’t provide an explanation himself. “We are the public health response officers and we follow advice from our experts to be ready,” he said.

Yesenia Amaro

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Cambodia - Ministry Tries to Reduce Infant Deaths

Health Minister Mam Bung Heng has instructed private hospitals and clinics throughout the Kingdom to establish services providing adequate care for infants with health problems in an effort to lower rates of maternal death and infant mortality.

Dated last Thursday, Mr. Bun Heng’s letter said that while his ministry continued to implement strategies to reduce deaths to both mothers and infants, it also needed collaboration from private medical establishments across the country.

The Health Ministry urged the owners of private hospitals and clinics with maternity services to create additional services to better care for infants in emergency situations.

“Directors of private clinics or private hospitals with maternity services must create services to save babies and collaborate with the capital and provincial health departments,” he said.

Leang Sreytouch, an employee at the Angkor Poly Clinic & Maternity in Phnom Penh’s Choam Chao commune, said her employer had yet to establish services to rescue newborns and had also yet to receive the ministry’s announcement.

“We will wait and see for a while. Maybe the doctor [clinic owner] will set up the service at this location, but now they are gradually processing it,” she said.

The ministry’s announcement comes after some Facebook users strongly criticized the health sector when a newborn with respiratory problems died after failing to receive medical treatment from several hospitals.

Last Tuesday, a man named Ruos Saruon wrote on Prime Minister Hun Sen’s Facebook page: “I took my newborn son who was crying and had difficulty breathing in an ambulance accompanied by two doctors to Calmette Hospital.

“They did not admit him and said there was no place. I took him to Kantha Bopha, but they also wouldn’t admit him. I took him to the National Pediatric Hospital, but it was too late and my son died.

“Samdech [Mr. Hun Sen] please check this problem, do not let Cambodian children die like this without helping just a little bit.”

Pech Sotheary

khmertimes

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Cambodia - Government Target for Eliminating HIV Pushed Back Five Years

Two years after Prime Minister Hun Sen vowed to eliminate new HIV infections by 2020, projections indicate the government will need another five years to reach its target.

Under pressure to increase government spending on HIV prevention and treatment initiatives in the face of donor funding cuts, Mr. Hun Sen declared the government would “not allow any successful program to go bankrupt” and allocated $3.7 million toward the efforts.

Compared to more than $224 committed by The Global Fund to Fight AIDS, Tuberculosis and Malaria since 2003, the number is small, but still significant for a government that has almost entirely relied on donors in the past.

While the country’s fight against HIV/AIDS has drawn international praise following a drop in the rate of infection among people aged 15 to 49—from 1.7 percent in 1998 to 0.6 percent last year—both the government and NGOs are grappling with a lack of funding and other challenges in meeting the goal.

In February, the Ministry of Health revised its plan for the elimination of new HIV infections—meaning fewer than 300 new cases being identified annually—pushing back the target date to 2025.

In a report, the ministry estimates that newly identified cases would be no higher than 474 per year by 2020 and gradually decline to a “virtual elimination of HIV transmission by 2025.”

In addition to external funding cuts, domestic migration, a lack of HIV awareness among young people and a poorly funded public health sector were contributing factors behind the decision to revise the target, UNAIDS country representative Marie-Odile Emond said on Thursday.

“The new target is by 2025 and we think there is a consensus that it’s probably realistic,” she said . “It is still five years before the global target so Cambodia would still be one of the first countries to achieve this.”

UNAIDS estimates that 73,000 Cambodians have HIV, or 0.6 percent of the adult population, and 15,000 of them have not been identified, she said.

“It’s a bigger challenge than we expected,” Ms. Emond said of reaching the elimination target. “You realize that it still requires big investments. You need to maintain the effort and at the same time adopt new approaches.”

Ly Penh Sun, director of the National Center for HIV/AIDS, Dermatology and STD, said on Wednes­day that donors had called for the government be more self-reliant and spend more of its own limited funds on prevention and treatment.

“That’s very challenging,” he said. “The transition is very difficult.”

Sonia Kohlbacher

cambodiadaily

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Myanmar - Interview with Minister of Health Dr Myint Htwe

Dr Myint Htwe, minister for health, presides over a ceremony in Nay Pyi Taw on August 10. Photo: Pyae Thet Phyo / The Myanmar Times

The World Health Organization (WHO) held its annual Southeast Asia regional conference in Colombo, Sri Lanka, from September 5 to 9. On the sidelines of the conference, The Myanmar Times’ Aung Shin spoke with Dr Myint Htwe, Union Minister for Health and Sport. The interview has been edited for clarity and length.

What have you mainly discussed at the conference?

The WHO holds these conferences annually to review what every country in the region has accomplished within the last year. Every country presents their health sector needs, and the regional health ministers discuss the WHO projects in their country and whether they are performing well or not. This year, our discussions have focused on non-communicable diseases and also universal healthcare.

What are the main health issues in Myanmar?

We are now starting in Myanmar to update our health information system. It is a very important step. In every country, conditions of disease outbreak and control depend on having precise statistics. Some countries make announcements about disease eradication and outbreak control with imprecise data. But every country needs to make sure their health information systems are strong. We call it “systematisation”. Without that, planning or projections can go wrong.

Is this your priority under the new government in Myanmar?

Yes, we have been starting on that. We have a lot to do for the systematisation of the health sector. The working procedures of the health sector, in all the ministry’s offices, need to be standardised. We also must standarise codes of ethics for all personnel in the health sector, such ethics for doctors, ethics for nurses and ethics for medical science. We are working on these issues.

The private health sector is growing fast in Myanmar, with most people relying on private hospitals and clinics. How will the Ministry of Health regulate the private health sector?

This is why we have the Myanmar Medical Council, which I chair. We have to cooperate with the private health sector and also monitor what they are doing to see whether their medical treatment is qualified or not, whether they are asking fair charges for treatment or not. We cannot let them operate without oversight. At the same time, we [the public health sector] have to monitor our health services too to ensure quality services.

Many people complain about the poor standards of medicine, with a lot of fake medicine distributed locally. How will the Ministry of Health control this private medicine market?

This falls under the responsibilities of the Myanmar Medical Council. People can complain to the ministry or file a medical case. The council will examine whether the case is true or not, and whether it is a mistake or misunderstanding. The medical council must monitor the whole medical service sector … So far not many issues or case have been received, only a few.

You presented something about the health budget at this WHO regional conference. What was it?

WHO has a lot of health projects in each country. They must review which projects are the more important. It shouldn’t happen that a large share of the budget goes to less important project. So the WHO has to review their budgeting system to ensure the most important projects get the most funding.

Another hot issue at this conference is the Zika virus. The WHO has confirmed Zika cases in Thailand, Singapore and Indonesia. What has Myanmar done to prepare for that disease?

We have standard procedure guidelines for all disease outbreaks. We have alerted all responsible departments and personnel. We are not careless about Zika or any disease outbreak. It is not an easy job if we have some infections of that disease.

There are some countries announcing they have officially eradicated some diseases, meeting the UN’s Millennium Development Goals. We have never heard of this happening in Myanmar. What MDGs has Myanmar achieved?

You should ask other the countries if these announcements are technically true or for a certification of their having met MDGs or eradicating particular diseases. Actually, no one has achieved the MDGs. It is impossible so far. The systematisation of the health sector is still poor.

Aung Shin

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Vietnam - Vietnam's health ministry wants to ban late-night sales of alcohol

Late night drinking in Hanoi's Old Quarter. Photo by VnExpress/Giang Huy

Health officials fret as the country is one of the biggest consumers of beer and liquor.

The Ministry of Health is considering a ban on sales of liquor and beer after either 10:00 p.m. or midnight as officials aim to reduce negative impacts of drinking.

Nguyen Huy Quang, director of the ministry’s Department of Legal Affairs, told a seminar in Hanoi on Monday that the ban is part of a new bill on alcohol consumption that is being drafted.

The proposal is based on similar bans already in place in several countries, which the official said have proved effective in curbing the impacts of drinking.

The bill is expected to be put before legislators in 2018.

Vietnam is currently the second biggest consumer of beer and liquor in Southeast Asia, only after Thailand; the 10th largest in Asia; and the 29th largest in the world, Vice Minister of Health Nguyen Thanh Long said.

“If prevention measures are not applied effectively, Vietnam may become the biggest consumer of beer and liquor in the world, not just the 29th,” Long said.

A new study jointly conducted by the ministry and the World Health Organization (WHO) shows that 77 percent of Vietnamese men drink liquor and beer, nearly half of them drink at hazardous levels.

Nguyen Phuong Nam, an official from WHO, said at Monday's seminar that nearly 67 percent of the total 1,840 traffic accident patients in the study had high concentration of alcohol in blood and 45 percent of them drove after two hours of drinking.

“Is Vietnam a start-up nation or drunken one?” he asked.

According to the Vietnam Beverage Association, local drinkers consumed a total of 3.4 billion liters of beer last year, up 10 percent year-on-year but surging around 40 percent from 2010.

On average, each Vietnamese person drank 38 liters of beer in 2015, more than four times higher than the global average.

The Ministry of Health said that half of drinkers drive after two hours of drinking. The Traffic Safety Committee also said that 40 percent of road-related fatalities, or some 4,000 deaths, were linked to drunk driving in 2015.

Drinking alcohol, including beer and liquor, increases the risk of developing cancers of the mouth, upper throat, voice-box, bowels, liver and breasts, health experts say.

Meanwhile, Vietnam still aims to produce 4.1 billion liters of beer in 2020, up from 3.4 billion liters in 2015, according to a plan for beer, liquor and beverage production until 2025.

Beer output will be raised to 4.6 billion liters in 2025 and 5.5 billion in 2035, according to the plan that has been made public recently by the Ministry of Industry and Trade. Liquor output is expected to increase to 350 million liters through 2020-2035.

Nam Phuong

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Myammar - 40% of health jobs filled: minister

The Public Health Department needs more than 58,000 staff but only 40 per cent of that number has been employed, Minister for Health and Sports Dr Myint Htwe has told the Lower House.

MP Dr A Zin Latt proposed a reorganisation of the department to extend and improve public health care. 

"The department is allowed to appoint 58,554 people, but we have been able to appoint only 40 per cent. We are now trying to recruit more staff," said Myint Htwe.

Too little expertise in the ministry and too few practitioners on the ground were holding health care back, he said.  

The minister unveiled a plan to reconstitute the department, including the appointment of about 2,000 doctors next year.

"We are planning to reconstitute the department to promote public health-care services such as vaccinations, school health, educational talks, effective health-care services and the elimination of infectious and chronic diseases," said the minister. 

Phochan

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Brunei - Brunei travellers advised to protect themselves from Zika

THE Ministry of Health (MoH) yesterday advised Bruneians who are planning to travel abroad, especially to Zika affected areas, to take personal protective measures to prevent mosquito bites during their trip.

The MoH issued the advice as the school holidays have just begun and families across the country are taking the opportunity to travel with their children, families and friends.

“However, some people are understandably concerned about the Zika virus situation in affected countries and may be rethinking travel plans,” MoH said in its latest statement on the Zika situation.

“Remember, pregnant mothers are advised to postpone any non-essential travel to Zika affected countries.”

According to the MoH, the personal protective measures to prevent mosquito bites during the trips include wearing long sleeves and light coloured clothing, applying insect-repellent regularly, and sleeping under mosquito nets or in rooms with air conditioning or screens.

“In the event that you or any of your family member become unwell, especially after returning from your trip, seek medical attention. It is also very important to note that at all times you must avoid mosquito bites before and after your trip to avoid further spread of the Zika virus. If your partner is pregnant and you have recently travelled to a Zika affected country, abstain from sex or adopt safer sexual practices for the subsequent duration of the pregnancy.”

The MoH said, “Although there are no reports of Zika virus in Brunei Darussalam, as a country we need to work together. Every person must play their part to prevent and control this disease, even those who are planning to travel abroad.

“Before leaving the country, spend some time to ensure that your house is clean and free from mosquito breeding sites especially if you and your family will be away from home for a while. Environmental cleanliness is the key and we can prevent mosquito breeding sites by emptying, cleaning or covering containers that can hold even small amounts of water, such as plastic containers, buckets, flower pots and tyres.

“A clean home free from mosquito breeding sites is one key aspect to keep us free from Zika.

“The Zika virus currently has no treatment or vaccine and preventive measures are the best course of action to be taken to protect you and your family from becoming infected.

“Such measures are even more important for pregnant mothers or couples planning to have children as the virus can affect the unborn child.

“Arm yourself with information on the Zika virus available on the Ministry of Health Website www.moh.gov.bn or you can contact Darussalam line 123. Clean up, Cover up and together we can prevent and control the Zika virus,” the MoH said.

borneobulletin

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Singapore - More clinics under probe for possible cheating

MOH has asked the police to look into more questionable subsidy claims under Chas

More clinics are under probe for possibly cheating the Ministry of Health (MOH) when claiming subsidies for patients under the Community Health Assist Scheme (Chas).

Two dental clinics have already been suspended from the scheme. The suspension will start on Friday.

MOH told The Straits Times that it has asked the police to look into more questionable claims, made by an unspecified number of other clinics, under Chas.

The scheme lets private clinics treat patients who are eligible for a government subsidy, and claim the subsidy from the ministry.

Last week, MOH announced the suspension of the two dental clinics - Phoenix Dental Surgery clinics in Ang Mo Kio and Marine Parade - from Chas. It had filed a police report against them for possible fraud on April 22.

Under Chas, MOH has to give a clinic 15 days' notice of termination, so the clinics facing suspension are on Chas until this Friday.

The ministry told The Straits Times it has "also referred other clinics to the police for further investigation". But it would not say if they are dental or general practice (GP) establishments. About 1,500 clinics are on the Chas scheme.

The possible cheating cases surfaced via regular audits by MOH and a patient's complaints.

In the case of the two dental clinics, the MOH spokesman said: "While we were auditing the clinics, we also received a patient complaint that Phoenix Dental had submitted claims for procedures which had not been done for the said patient."

Associate Professor Patrick Tseng, Singapore's chief dental officer, said: "MOH takes a serious view of fraudulent claims and unlawful practice behaviour, and we will take necessary action if we suspect any such activity."

The audits have turned up cases of non-compliance, but many are unintentional or administrative errors, such as putting down the wrong date for a procedure. They have also turned up more questionable "errors", such as:

Doing a simple procedure but making a claim for a more complex, and hence more expensive, treatment.

Making claims for procedures that are not eligible for subsidy, by classifying it as a different procedure that is subsidised.

Making a full claim although the treatment has not been completed.

Claiming for a procedure that was never done.

The MOH spokesman said the ministry will recover any subsidies paid out through incorrect claims. Last year, Chas paid out $167 million in subsidies to GPs and dental clinics for treating 650,000 Singaporean patients.

Salma Khalik

straitstimes