| Thailand and other Asian countries affected by the Dec 26 tsunami must set aside their image-building and concentrate on the lessons learned from that catastrophe to boost cooperation and be better prepared for future disasters.
That process can begin today with the opening of a meeting in Phuket on the impact of the tsunami on health in Asia. Delegates will discuss how serious are regional governments about improving the immediate response to killer waves.
The Thai government wants to use the forum to review what has been done in terms of a health response and to push for a framework of cooperation among all concerned, including governments and non-government organisations, according to Dr Vichai Thienthavorn, the permanent secretary for public health.
''We never thought there would be such a natural disaster in Thailand,'' he said. ''The tsunami was a reminder that we need to learn more from other countries about ways to deal with psycho-social stress and the management of body identification.''
Unlike in other countries hit by the tsunami, Thailand's health-care system won praise for its swift response to the devastation in the six provinces affected along the Andaman coast . The initial problems of trauma and disease are now under control, thanks to a well-developed health infrastructure and good basic care, especially in Krabi, Phangnga and Phuket, which boast several well-equipped medical centres.
Dr Vichai said the arrival in affected areas within the first 48 hours of 200 emergency medical staff and thousands of volunteers had helped the health system already in place.
According to a report in the British medical journal Lancet, this response contributed to a low mortality rate of just 0.3% among the more than 8,000 patients seeking hospitals care. There also has been no sign of a major outbreak or killer pathogens in local communities. The most common ailments have been non-cholera diarrhoea and infected injuries.
Although the threat of an outbreak of disease has receded, dealing with the psycho-social impact of the tsunami remains a major challenge. Thousands of local residents have lost family members and suffered damage to property and their means of earning a living.
Apichai Mongkol, deputy director-general of the Mental Health Department, said it was impossible to help the survivors in the short term get through their mental trauma.
The department has rotated teams of psychiatrists in tsunami-affected communities so they they served for up to two months at a time, but he said it normally took at least six months for most people to recover, and several years in the more serious cases.
The government must learn from other countries that have experienced repeated natural disasters rather than simply promote the tourism industry and rebuild infrastructure, he said.
Identifying the bodies of the victims has been another difficult task. This is the first time forensic skills, with modern identification methods like DNA typing, have been in such demand after a natural disaster. Not every country has enough trained staff to respond to such a challenge, said Pol Maj-Gen Chumsak Phruksapong, director of the Forensic Science Institute.
The Thai Tsunami Victims Identification Centre was engaged in identifying bodies taken to Wat Yanyao and Wat Bang Muang in Phangnga's Takua Pa district. The process of identifying all the bodies and returning those of foreigners to their home countries continues four months after the disaster. An international team was rushed to assist identify more than 5,000 foreigners.
Dr Kamnuan Ungchusak, director of the Epidemiology Bureau, said representatives of countries hit by the tsunami attending the Phuket meeting would discuss the possibility of drafting an international standard on the management of body identification.
Learning from outbreaks such as Sars, or severe acute respiratory syndrome, and bird flu, the bureau has set up a real-time surveillance system for tracking and responding immediately to possible outbreaks of disease.
Dr Kamnuan believes those responsible for body identification could draw on lessons learned from Sars and bird flu to develop a unified operation which would enable them to cope better should there be another natural disaster.
NGOs working with local communities hit by the tsunami believe the authorities should not neglect other factors important to good health, such as clean water, good sanitation and food safety, which should be put in place as soon as possible.
Prapan Tawichart, a volunteer with the Foundation for Children working at Moken villages in Phangnga's Takua Pa district, said almost half of 140 affected children suffered from malnutrition and asthma as a result of the poor management of sanitation at their camps and shelters.
It is also essential, Ms Prapan said, for health workers to pay more attention to remote villages in lightly affected areas _ for example, by disseminating data on hygiene and healthy living _ rather than rushing to badly hit zones like Ban Nam Khem in Takua Pa only to find there was nothing for them to do there.
Pakpoom Witantirawat, an executive with the Save Andaman Network, suggested that the government grant local people affected by the tsunami a greater role in deciding their future. The government should also have a clearer policy based on people needs and individual situations rather than act without heeding the public.
William Aldis, the World Health Organisation representative in Thailand, said the international meeting on the health aspects of the tsunami was needed so Asian countries affected by the disaster could discuss their experiences and deal with the aftermath more effectively.
Thailand would be able to exchange details of its effort and how effectively it had responded to the disaster through health surveillance and volunteers, he said.
''I'd like to hear more about what went wrong and what needs to be done than what went well,'' Mr Aldis said. ''It's because the sooner the problem is addressed openly, the sooner Asian countries can establish better preparation for a possible natural disaster like a tsunami.''
By: Bangkok Post, Thailand
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