An Asia-Pacific Academic Consortium for Public Health collaboration (APACPH) team visited Sri Lanka during May 5-ll, 2005 to identify areas in which APACPH member institutions can best collaborate with local educational institutions. APACPH delegates visited 2 universities and several health facilities to hold discussions with health professionals about this issue. The main challenging areas proposed by health professionals of the tsunami affected regions were the nurturing of local health professionals and mental health care.論文http://purl.org/coar/resource_type/c_650

Chiu Wen-ta

Hokama, Tomiko

Johnson, Anderson

Palmer, Paula

Patrick, Walter K

Rouse, Carolyn

Rouse, Ian

English

University of the Ryukyus Repository

琉球大学学術リポジトリ［調査報告］Post Tsunami Sri Lahka-Asia-PacificAcademic Consortium for Public HealthCollaboration : Field trip report言語: English出版者: 琉球医学会公開日: 2010-02-23キーワード (Ja): キーワード (En): Ryukyu Medical Association, Sri Lanka,APACPH, public health human resource, mentalhealth,post tsunamic ollaboration作成者: Hokama, Tomiko, Patrick, Walter K, ChiuWen-ta, Rouse, Ian, Rouse, Carolyn, Johnson,Anderson, Palmer, Paulaメールアドレス: 所属: メタデータhttp://hdl.handle.net/20.500.12000/0002015622URLRyuhyuMed.J"24(2)103-107,2005 103PostTsunami SriLahka-Asia-PacificAcademicConsortium forPublicHealthColatx)ration -Fieldtripreport-TomikoHokamal),WalterK Patrick2),Wen-TaChiu3),士anRouse4',CarolynRoused)AndersonJohnson5)andPaulaPalmer5)1)DepartTnentOfMaternal& ChildandGlobalHealth,SchoolofHealthSciences,FacultyofMedicine,UniversityoftheRyuhyus2)UniversityofHawai,3)TaiwanMedicalUniversity4'CurtinUniversityofTechTWlogy,5)UniversityofSouthernCalifornia(ReceivedonOctober17,2005,acceptedonOctober24,2005)ABSTRACTAnAsia-PacificAcademicConsortium forPublicHealthcolaboration(APACPH)team visitedSriLankaduringMay5-ll,2005toidentifyareasinwhichAPACPHmemberinstitutionscanbestcolaboratewithlocaleducationalinstitutions.APACPHdelegatesvisited2universitiesandseveralhealthfacilitiestoholddiscussionswithhealthprofessionalsaboutthisissue.Themainchalenglngareasproposedbyhealthprofes-sionalsofthetsunamiaffectedreglOnSWerethenurturingoflocalhealthprofessionals年ndmentalhealthcare.RyuhyuMed.J.,24(2)103-107,2005Keywords:SriLanka,APACPH,publichealthhumanresource,mentalhealth,post-tsunamicolaborationINTRODUCTIONTheDecember26th2004southeastAsiatsunamiaffectedseveralcountriessuchasIndonesia,SriLanka,India,ThailandandtheMaldives.Atotalofmorethan100,000deathswerereported.ⅠnthecaseofSriLanka,thetsunamihit140fSriLanka'S28districts,kilingmorethan31,000andinjurlngmorethan23,000with5,000misslng.Almost575,000peo-plewerelefthomelessl).AnAPACPHteam (headedbyProfessorWaLterKPatrick)visitedSriLankaduringMay5-ll,2005.APACPHisaninternationalorganizationofpublichealthteachingandresearchinstitutionsintheAsia-PacificreglOn.Fifty-twoinstitutionsfrom18Countriesparticipateinthisconsortium.TheauthorjolnedthevisitingteamasamemberoftheAPACPHdelegation.Thepurposeofthevisitwastoidentifyareasinwhichwecouldbestcolaborate,playamajorroleandprovideasupportiveroleinpartnershipwithin-countryandexternalagenciesandlocalinstitutions.Inordertocolectinformationforthispurposewevisited2universitiesandseveralhealthfacilitiesinthetsunamiaffectedreglOnS.VISITEEDSITESANDINFORMATIONCOLLECTIONMETHODOverviewofSriLanka,vitalstatistics,healthcareindicatorandtsunamidisaster-relateddata/in-formationfromtheWorldBankandWHOreportswereprovidedtoteammembersbytheteamleader.WevisitedtheSriLankaWHOofficeinColombo,EasternUniversityofSriLanka(EUSL),theGen-eralHospitalofBatticaloa,theCounselingCenter,Children'srehabilitationsitesandvilagesaffectedbythetsunamiinBaticaloaDistrict,GaleUniver-sityandvilagesaffectedbythetsunamiinGaleDistrict(Fig.1).Discussionwithhealthprofession-alsanddatacolectionwascarriedoutatthevisitedsitestogetinformationaboutidentifyingpossiblecolaborationareasbetweenlocaleducationalinsti-lOL SrilbTILn･∧PACPHCqtlatmrtL加EITAblolLleAlth山tJSllE3120XH1㌔f'tldttOLIlthousaJdBILJrccTILW LgJuTlqtbirthlym TBllFl.JLrlL lnprhtiLylnklp:rLrOllLVebirthMIUrIかr･.51mrLJllit1 7nLeM仙･rTULlr7t-rU.1叫 nlEJl(Fyr]佃.OudblrE7pJIl〉rI■■VtlLrLhwiJlhLIo r tmt>ye'lr-L)l山 ruli･nr'1iIIJn'山 AJEnLn.LitT)ryTBtln耶 IcS l■ndLLJkrmL肪i汚1 -'foltlt._vrLlr-dl山 ru仙 iコtllmnはLJpoHhl'て こに 誓 ､､…~ 三 ;㌔･｣ ､･ エ㌻ TL J J T｢十 日i'~こ 1._/ 1r■■'■■■I聖≡Iだニ_..■■-I円はーS兜と田崎Fig.lVi㌔iLed lCiLJl一tA山o馳S Md P̂ACPH mt･悶ヒ吋rl悶t弓tutiOilS,Tl稚nEljJISOurtX!OrdE)tL乱EIJrm rd付目eetedwet-eRc-FPrlofWHOnrldLhep71oi什tProposaldm mC如TTl0mEUSLIIl瓢 ULTShOtqnricwofSrH.A)nkJlSJ･iI.nlltfH5;anISLandpOtLOFllo印d orr111esout41柑凱伽 gLOrlnJh.Wjlコ&lEIrTJnJIJEDl66,棚kmZ:smAnf"tlAnho拙ilido,btIlb如 eJ･t地nTdi･叫M ,Th.lota]pt叫ul一LiEmis19mjmon_PriαrLO;tscol耶払山T)hl･I:uropc8n COultrip_5.SrjLJIFlkElhadiLlonghib･bry 弘bnh】dt!JWnJpntkiJlgtb7TLl一四imediLEiRJepf･rLdpnrf･lrorTIGrcLnLEiritLiplhl朗8.Until)972Lbt!nationWBBkJIOⅣnJ)BCeylon.tntll一Lyearitsm8m P VLr的 亡hAn耶dtoSriLamk臥 !nl弛古拙ccBpi岨】city w姐 m耶細 rmm CoLomLx)ltコSJ･i JlyA､qlrt)でl岬tHn 1紬LLt･. l刀坪山!OrtLnO71即mgdvnwElrhrtheP一成20y仰 rS.theheOlh軸 Listi田pLu ･nLCdsJILJ､鴨 8m!hJLiWl･bhtJ]BSiLu且ti伽LTab]el且hl)W与r.eCtmth冊)L軌flttJfl;ndimtol･SQ(SriLAFlb ,JurL帆ChlnrhnLmo仙 IitymtejsIひWt!rTYlAtivetootherAE;iFln叩UnlJieSWMlinLheSOtJ山-他且L'tsLArt･g10n.mALerftaJmorLtlliLymu)yLIJ相92pLLr100IOOOljvモbirth:i.h280.1zTherivilw8r一弓innlJ-C'n即OflLleh和tLhsy書Lcmh姐如 爪印rl引JcIqLILq es･叩⊂】AHyinNorthernJlndmts.Lc】･nSrH.anka.071I.lCotlⅦThaJTd LhcLh他 ILh仇rC町SLeml氾且t把やn血 かagedinLhe'LBun8171ia,rf由 ed EI相 は QrSlilAnk8■日ROlthef.Flrifhd他呈tOrFl印rjtALrACgLO)JS.Table2sl亡岬Sl九enumberorJ軸Ih8/mjfLS.ing.d8m喝eJhDu等僧and血 ETul如 h組】Lhlrl丸itutiorls'1.ThujSl.inBddiLionLoikeinTlu別lf80fLht!dvibwar.theFtLIttll甘Id血 】mumF)-iedthedhmq即 lnihe 亡伽Staht･gl肺 Oh hcNDrll⊃cEIEIJ]JHokamaT.e£αJ.Table2Populationanddamagesfrom tsunamibydistrict105population death/missing damagedhouse damagedhealthinstitutionsNorthernProvinceKilnOChchiJaffnaMulaitivu152,000589,000141,000EasternProvinceTriconeleeBatticaloaAmpara486,447 3847 17405605,000 11477 29077SouthernProvinceHambantotaMataraGale525,370761,236990,539WesternProvinceKalutaraColomboGampahaPuttlam1,060,8002,263,1002,066,100705.30034791972671339731928Table3Distributionofmedicaldoctors(2000)andmaternal&childhealthstatistics(2002)MD/100,000 IMR‖ MMR2) LBW3) %ofimmunizationNorthernProvinceKilinochchiJaffnaMulaitivuEasternProvュnceTriconeleeBattlCaloaAmpara91 2.0 60.25 11.8 9.4143 14,6 116,10 19,4 95167SouthernProvinceHambantota 146Matara 215Gale 461WesternProvinceKalutara 380Colombo 2240Gampaha 611Puttlam 19255,05 16,3 8914.86 16.8 9535,96 18,8 941)infantmortalityrate(perl.000livebirths) 2)maternalmortalityrate(perlOO.000births) 3)lowbirthweight2.BaticaloaDistrict,EasternProvince verysmalinfantswereadmittedintoanon-air-IntheBatticaloaDistrict,EasternProvince, conditionedroom withtheiryoungmothers.Fourwesaw severalmilitarypersonneloneveryroad. patientswithmalariawereadmittedonthatday.ThetownofBatticaloawasveryquiet.Whenwe The Pediatrician at the General Hospital ofvisitedtheGeneralHospitalofBatticaloa,Several Batticaloainformedusthatthenumberofchildren106 SriLanka-APACPHColaborationwithpsychosomaticsymptomswasincreasinglntsunamiaffectedareas.Theworkloadseemedtobeheavyforonepediatrician.Despitethis,themedicaldoctorwaszealousincarrylngOutherwork.TheCounselingCenterwasnexttotheGeneralHospital.Thebuildingwasrathersmal,and therewasnofultimestaffprovidingcounseling:onlypart-timers.Regardless,thestaffcarriedouttheirworkdiligently.RehabilitationserviceswereprovidedbyNGOs.Theinstitutionwaskeptinagoodsanitarycondition.Thedirectorbriefedusthatitwasdiffi-culttokeepapermanentstafftomanagehiscenter.Accordingtothe"ProjectproposalforthedevelopmentoftheFacultyofHealth-CareScience,EasternUniversity",al medicalschoolson SriLankaaresituatedinthewesternhalfofthenation4).ThereisnomedicalschoolintheeasternhalfofSriLanka.AstheBatticaloaDistrictdoesnothaveamedicalschoolyet,medicaldoctorshavetobetrainedatamedicalschoolasfarawayasColombo.TheneedforamedicalschoolintheEasternProv-inceofSriLankahasbeenlongfeltasurgent.ThemedicalandhealthstaffofEasternUniversitycom-plainedthatitisdifficulttokeepyounghealthpro-fessionalsthathavebeen trainedin theWestProvinceorinforelgnCOuntries.Themainreasonistheirunwilingnesstoreturntotheirorlglnalinsti-tutionsintheeasternreglOn.ThereforeachronicshortageofhealthprofessionalsexistsintheEastProvince.Table3Showsnumberofmedicaldoctorandmaternalandchildhealthstatisticsbydistrict3,4)･MaternalmortalityrateishigherinNorthernandEasternprovinceswherethenumberofdoctorsarefewrelativetotheWesternProvince.3.GaleDistrict,SouthernProvinceTheatmosphereinthetownsoftheGaleDis-trictwasslightlybusierthanintheBaticaloaDis-trict. WedidnotseeanysoldiersintheGaleDistrict. A psychiatristfrom theGaleDistrictstatedthattheprevalenceofmentaldisordershadincreasedalongwiththerapidsocialandeconomicalchangesthroughoutalofSriLanka.Furthermoreshewasconcernedabouttheincreasingnumberofadultswithdeprivedmentalhealthafterthetsu-naml.ProvidingmentalhealthcareservicesforchiLdrenandadultswholostfamilyandpropertywasanurgentissue.However,therewerenohospltalsorhealthcentersthathadsufficientmentalhealthCareprogrammesandprofessionalspreparedforsuchadisasterintheaffectedareas.4.ActionplanforcolaborationAMemorandumofUnderstandingfortheDe-velopmentofAcademicCooperationbetweentheEasternUniversityofSriLanka(EUSL)andtheAPACPHwasmadeafterdiscussionswereheldbydelegationsofbothinstitutions.Thecontentsofthememorandum are:①TheestablishmentofajointscholarshipfundwithEUSLforstudents,(亘℃onsu1-tationwithEUSLtodevelopamemorandumofun-derstandingwithindividualUniversities,③APACPHandEUSLhaveagreedthatthetwoorganiza-tionswilcooperateintheexchangeofinformationrelatingtotheiractivitiesinteachingandresearchinfieldsofmutualinterests,and④Bothorganiza-tionswilalsopromoteappropriatejointresearchprojectsandjointcoursesofstudy,Withparticularemphasisoninternationalyfun°edprojectsandonthedevelopmentofcurriculawhichareofparticularrelevancetotheunlqueCultural,environmentalcir-cumstancesinSriLanka.Thedraftofthememo-randum ofunderstanding was slgned by theAPACPHdelegationandtheEUSLchancelorandvice-Chancelor.DISCUSSIONTherearedisparitiesbetweentheindustrial-izedWestProvinceandtheotherprovinceswhicharelessdeveloped.TheEastofSriLankaislessde-velopedwithregardtoinfrastructure,healthcaresystem andinstitutions. Thecivilwarongolngsincethe1980'S,hashadadetrimentalinfluenceonsocio-economicactivitiesintheEast.Thetsunamidisasterexacerbatedthisdisparity.Themainrea-sonforthechronicshortageofhealthprofessionalsthatexistsintheEastProvinceseemstobetheun-wilingnessofthehealthprofessionalstoreturntotheEast.InordertoresolvetheseissuesEasternUniversityhasplanstoestablishamedicalschool.Establishingamedicalschoolisthebestwaytokeephealthprofessionalsinthearea.Therefore,nurtur-inglocalhealthcareprofessionalsisoneofthemainareasforcolaboration.WhenwelookatthecurrentsituationinSriLanka,WecanseethatithasmuchincommonwiththeproblemsfacedbyOkinawaduringthedevelop一mentofhealthcaresystemsaftertheBattleofHokamaT.etal.Okinawa.Majorsimilaritiesareintheareaofalackofhealthprofessionalsanddisparltylnthehealthcaresystem.ThefactorsforOkinawa'sdra一maticsuccessfulpostwar rehabilitation in thehealthcaresystem arefoundinitscharacteristicprlmaryhealthcareprogrammeandinthenurtur-ingofhealthprofessionalsthroughsupportfromthenationalgovernment.Inordertoretainhealthprofessionals,theFacultyofHealthSciencewases-tablishedattheUniversltyOftheRyukyusin1969.Furthermore,inordertokeepmedicaldoctorsinOkinawatheFacultyofMedicinewasbuiltattheUniversltyOftheRyukyusin1980inaccordancewiththewishesoftheOkinawanPopulation.OfJapan'S47prefectures,Okinawawasthelastonetohaveamedicalschool.HealthprofessionalsofSriLankamayrefertoourexperiencesinthedevelqp-mentofOkinawa'shealthsystemandstructures.Withregardtotheincreaslngnumberofbothchildrenandadultsafflictedbymentaldisorders,thecreationandimplementationofmentalhealthcareservicesforthevictimsofthetsunamitragedyisanurgentchalengethatneedstobemet.Accord-1ngtOthereportfromJaffnaDistrict,40%ofchil-dren(aged8-15)wereatriskofdevelopingposttraumaticstressdisorder3). InJapananation-wideinvestlgationinthe1960'sshowedthatthepreva-lenceofmentalhealthdisordersinOkinawawasseveraltimeshigherthanthatofalJapan5'. onepossiblereasonforthisresultmaybethedevasta-tionofnatural,socialandhumanresourcesonOkinawacausedbytheBattleofOkinawa.Al-though disastermanagement,including mentalhealthcare,arecommonissuesandcommongoalsthesedays,therearefew studiesonthementalhealthandcaresystemintheaffectedpopulation.Thereforeincludingmentalhealthandcaresysteminlongtermdisastermanagementseemstobeanappropriatecombinedresearchthemeforcolabora-tion.Asa memorandum ofunderstanding was107made,thefeasibilityofacademiccooperationbe-tweenEUSLandeachAPACPHmemberinstitutionistobediscussedaccordingtothememorandum.CONCLUSIONObservationofthetsunami-hitareasofSriLankashowsthattherealityofthisdisasteranditseffectsonthehealthsystemarebeyondourimag1-nation.ThemainareasproposedforcolaborationbetweenlocalinstitutionsandAPACPHmemberin-stitutionswerenurturinghealthprofessionalsandmentalhealthcare.DiscussionsondeveloplngSuS-tainablecolaborationintheteachingandresearchofthesethemesisneededfolowlngthememoran-dumofunderstanding.Appropriatefun°inglSnec-essarytodevelopthisactioninthenearfuture.ACKNOWLEDGEMENTWewishtoacknowledgetheAPACPHExecu-tive,coleaguesfromSriLankawhosupportedandparticipatedinthisfieldtrip.REFERENCE1)UNICEF,IndianOceanEarthquakeandTsu-nami,UNICEFresponseat90days,P.13,2005.2)Ataglance:SriLanka,Statistics,http//www.unicef.org/infobycountry/.srilanka.statistcs.html.3)HealthsystemintheTsunamiAffectedAreasofSriLanka,WHO,SriLanka,CDRon2005.4)ProjectProposalfortheDevelopmentoftheFacultyofHealth-CareSciences,EasternUni-Versity,SriLankaintheTsunamiAffectedBatticaloaDistrict,EasternUniverslty,2005.5)ReportofmentalhealthinOkinawa,p.19,TheOkinawaSocietyofMentalHealth1966(inJpn).

［調査報告］Post Tsunami Sri Lahka-Asia-Pacific Academic Consortium for Public Health Collaboration : Field trip report

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［調査報告］Post Tsunami Sri Lahka-Asia-Pacific Academic Consortium for Public Health Collaboration : Field trip report

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