MEKONG INFECTIOUS DISEASE BEHAVIOR CHANGE COMMUNICATION ...€¦ · This publication was prepared by The Mekong Infectious Disease Behavior Change and Communication Project, managed

MEKONG INFECTIOUS DISEASE BEHAVIORCHANGE COMMUNICATION PROJECT (MID-BCC)

End-of-Project Report

SEPTEMBER 2012

In 2009, the U.S. Agency for International Development/Regional Development Mission in Asia (USAID/RDM/A) awarded AED, a Washington-based non-

governmental organization now known as FHI 360, a three-year Associate Cooperative Agreement (No. AID 486-A-09-00006) under Leader Award No.

GHN-A-00-07-00004-00. This associate cooperative agreement project, titled Communications in Change for Infectious Diseases in Greater Mekong Sub region, is

also known as the Mekong Infectious Disease – Behavior Change and Communication (MID-BCC) Project in short. The technical focus of this Project was to reduce

outbreaks of avian and pandemic influenza (API), malaria, and other public health threats (specifically dengue) in the Greater Mekong Subregion (GMS) countries.

mekong.aed.org <http://mekong.aed.org>

This publication was prepared by The Mekong Infectious Disease Behavior Change and Communication Project, managed by FHI 360, and funded by the United

States Agency for International Development (USAID)/Global Health under Client Associate Award Number GHN-A-00-09-00002-00 under Leader Award

(C-Change) No. GPO-A -00-07-00004-00. It does not represent the views of USAID or the U.S. Government.

2012

ContentsIntroduction 4

The Foundation of this project 6The Research Base 8

Diseases of Interest 9

Framework for Cross-Border Initiatives 10Research: Mukdahan-Savannakhet Border Area (Lao PDR and Thailand) 11• CaseStudy:EngagingCommunitiesintheMonitoringofMarketPricesontheMukdahan,ThailandandSavannakhet,LaoPDRBorder 13

Collaboration: Champassack – Ubon Ratchatani Border Area 14

Research: Luang Namtha Border Area (Lao PDR, Burma, China) 14

Research: Bokeo, Lao PDR 15

Research: Rapid Assessments in Trat and Chiang Khong, Thailand 16

Research: Burmese Migrant Workers in Phuket, Thailand 19• Migrantworkerriskassessment 19• Learningtocommunicateeffectively 20• WhattheKAPsurveydetermined 20• Therisksofcontractinginfluenza-likediseases 21• Bestchannelsofcommunication 21

Research: Supply Chain Actor Mapping Along the Mukdahan Corridor Across 22 Thailand, Lao and Vietnam

Accomplishments 24Accomplishments in Avian Influenza Prevention and Control 26• CaseStudy:EngagingtheLaoWomen’sUniontoAvertInfectiousDiseaseOutbreaksvia InformationSharing 26

• RiskCommunicationCapacityBuilding 29• DidAllThisTrainingandOutreachMakeaDifference? 30

Accomplishments in Dengue Prevention and Control 33• PreparingUsefulMaterialstoEducateonDengue 34• EducatingtheMediaonDengue 34• HelpingMedicalProfessionalswithClinicalCaseManagementofDengue 35• AdvocatingforMoreCooperationfromCommunitiesinPreventingandControllingDengue

Accomplishments in Emerging Infectious Disease Preparedness 36

Accomplishments in Malaria Prevention and Control 37• Pre-TestingofLowLitMaterials 38

Threads of Sustainability 40• ParallelswiththeGlobalHealthInitiative 42

Vigilance for Emerging Infectious Diseases 42

Our Own Words: Notes from the Blogosphere 44Revisiting the markets in Lao PDR: Avian Influenza Risk Reduction Campaigns before the Pi Mai 46

Learning Advocacy: Building from What is Known to Unknown 50

Dhammayietra 22: Avian Influenza prevention during the annual monks’ peace walk in Cambodia 56

Avian Influenza Prevention in Cambodia: Community Forums 61

MID-BCC in Cambodia: Training the Frontlines on Risk Communication 66

MID-BCC in Cambodia: Training the Frontlines on Risk Communication, Part II 70

High Risk Communication Training In Battambang, Cambodia 76

One Community, One School, One Health 80

Strengthening the Risk Communication Capacity of Cross-Border Provinces: Savannakhet 85 and Champasack

4 Mekong Infectious Disease Behavior Change and Communication (MID-BCC) Project | End-of-Project Report September 2012

In2009,ontheheelsof thefirstinfluenzapandemicof

the21stcentury–therelativelymildH1N1outbreak–the

globalpublichealthcommunitywaskeenonmaintaining

themomentuminpreventingandcontrollingoutbreaksof

influenza-likeviruses.Indeed,agooddealof progresshad

beenmadesince2005,whenoutbreaksof avianinfluenza

(AI)wereregularoccurrencesinSoutheastAsia,leading

tothedeathsof over140milliondomesticpoultryand57

people–andsparkingconcernamongpublichealthofficials

thattheH5N1wouldmutateintoadeadlypandemicvirus.

Intheend,itwasnotH5N1inAsia,butavirusoriginating

inpigs(H1N1)andbreakingoutfirstinMexico,that

circulatedaroundtheglobeandledtheWorldHealth

Organizationtodeclareapandemic.

Introduction

5

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Mekong Infectious Disease Behavior Change and Communication (MID-BCC) Project | End-of-Project ReportSeptember 2012

Amidsttheflurryofpost-pandemicanalysisin2009,afewkeypointswerelargelyoverlooked.First,preparingforapandemicwasausefulexerciseformanycommunitiestobecomemorepreparedforawidervarietyofbiologicalandotheremergenciesfromemerginginfectiousdiseaseoutbreaks,toearthquakes,tohurricanes,toviolentsocialdisruptions.Second,theprocessofpreventingandcontrollingAIoutbreaks,andpreparingforapossiblepandemic,revealedpracticesandprocessesthatwouldbenefitglobaldisasterpreparednessiffollowed.Finally,

theH5N1viruswasstillcirculating,especiallyinSoutheastAsia,andstillposedathreattocommunitiesintermsoftheirhealthandlivelihoods.

USAIDwasamongdonororganizationsthatdidnotoverlookthesepoints.Withoutdoubt,progresshadbeenmadeundertheglobalAI.COMMprojectandSoutheast-Asia-basedAI-BCCprojects,whichusedbehaviorchangeandcommunicationtoolsandapproachestofendoffoutbreaks.ItwasonthisfoundationthattheMID-BCCprojectwasconstructed.

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BoththeAI-BCCandAI.COMMprojectsusedanintegrated

communicationapproachthatemployedavarietyof methods

andchannelstoprovideinformationandpromoteprotective

behaviors.Hearingthesamemessagesfromtrustedsources

anddemonstratingbasicbutfeasiblehealthypractices–

sanitationandhygiene,separationandisolationof poultry,

andreportingoutbreaksimmediately–canmakeadangerous

virusmanageableandlessthreatening.

Basedonqualitativeandquantitativeresearch,theprojects

employedavarietyof toolstodeliverinformationongood

practicesandbehaviors:Acombinationof massmedia,social

mobilization,advocacy,community-basedcommunication,

interpersonalcommunication,publicrelationsandsocial

mediaweretailoredtoacountryorasituationandusedto

demonstratebeneficialpublichealthpractices.Inmostcases,

AI-BCCmobilizedexistingsocialnetworkstohelpeducate

andeffectpositivebehaviorchange.

TheFoundationof theProject

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7Mekong Infectious Disease Behavior Change and Communication (MID-BCC) Project | End-of-Project ReportSeptember 2012

See:http://avianflu.aed.org/docs/AI.BCC_EOP_8.17.101.pdffor the AI-BCC final report and http://avianflu.aed.org/docs/AI.COMM EOP_7_62810.pdf for the AI.COMM final report.

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Similarly,MID-BCCusedanintegratedapproachthatincludedresearch;segmentationofat-riskaudiences;engagingcivilsociety,thepublicandprivatesectors,andcommunitiesinlocal-levelcommunicationactivities;andcapacitybuildingandtraininginareasrangingfrominfectiousdiseasetointerpersonalcommunication.MID-BCCalsobenefittedfromthe“OneHealth”orientationthatglobalpublichealthofficialshadincreasinglyembraced.TheOneHealthconceptisaworldwidemovementtomakebetterconnectionsbetweenallthedifferenthealthcaredisciplines:animal,human,environment.Thetheorywasthat,byunitingtheseformerlydisconnectedfields,publichealthwouldbeenhancedandprogresswouldbemadeinpreventing,controlling,andtreatingdisease.Inpractice,however,itwasoftenchallengingtobringthesepartiestogetherunderoneroof,especiallyatthebeginning.Inmanycountries,MinistriesofHealthrarelyinteractwithMinistryofAgricultureorForestryorAnimalHealth.

TheResearchBaseThebedrockMID-BCCactivitieswasasolidevidencebase.Indeed,underMID-BCC’spredecessorprojects–AI.COMMandAI-BCC–FHI360quicklyrealizedthatchangingpeople’sbehaviorrequiredasoundscience-basedunderstandingofwhatpeopleactuallydoandwhytheydoitthatway.Toobtainanswerstothosequestions,FHI360createdandfine-tunedsomeveryusefulsurveytoolstoelicitdetailedinformationaboutat-riskgroupsofpeople(seeboxbelowforanexample).ThiscreatedastrongfoundationonwhichtobuildcontinuingeffortsunderMID-BCC.

AsintheAI-BCCandAI.COMMprojects,thefirstphaseoftheMID-BCCprojectfocusedonformativeresearchandtrainingoflocalcounterpartstoengageinparticipatoryresearch.Unlikepreviouswork,however,MID-BCCadoptedacross-borderfocus,

concentratingonareaswheretrade,communication,andotherconnectionswereforgedbetweencountriesintheGreaterMekongSub-region.Inpart,thedecisiontofocusonborderareasflowedoutofriskmappingexercisesandsupplychainanalysesofboththeformalandinformalpoultrymarketsthatwereundertakenunderthepreviousprojects.Thesestudiespinpointedtheareaswhereinfectionscouldbeintroducedintothesupplychainandthepopulationoverall,andhelpedtobettertargetinterventionsinthoseareas.

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Justastheglobalizationoftradeandtravelisrapidly

evolving,soistheglobalizationofinfectiousdiseases.

Evenwhendiseasesarelocalinorigin,theycanpose

animminentandongoingglobalthreatiftheyarenot

controlledattheirsource.Borderareasareparticularly

importantforemerginginfectiousdiseasecontroldueto

theinformalandsometimes-illegalmovementofpeople

andliveanimals,andcross-bordertradeoflivestock,

livestockproductsandwildanimals.InAsiaandthe

GreaterMekongSub-regioninparticular,themovement

ofpeopleamongcountriesoftheRegionisintensedue

tothebothheavyandwell-connectedair,seaandroad

transportnetworkthatlinksbothmega-citiesandrural

villages.Theseconditionsfacilitatetherapidspreadof

infectiousdiseases.Therefore,findingouthow,where,

andwhendiseasesspreadacrossbordersisanimportant

firststepindevisingstrategiestohaltthemattheirsource

andminimizetheirimpact.Theresearchconductedby

theMID-BCCproject–includingRapidEthnographic

Appraisals,ParticipatoryActionResearchandKnowledge,

AttitudesandPracticessurveys–contributedtothis

evidencebase.Moreover,thesubsequentconnections

forgedbyindividualsandtheircounterpartsacrossborders

toshareinformation,buildskillstogether,andcollaborate

ondiseasepreventionandcontrolactivitieswillcontinueto

yielddividendsinthefuture.

Diseasesof InterestThediseasesselectedforfocuswereavianinfluenza,dengue,andmalaria.Atthebeginningoftheproject,eachdiseasehaditsownbasketoffundingfromUSAIDthattheprojectcouldtapinto.

Astheprojectprogressed,however,fundsspecificallyallottedfordengueandmalariadwindled–partlybecauseinterventionsformalariawereshiftedandconsolidatedunderotherprojects.Moreover,theapprovedworkplansdictatedthatMID-BCC’sroleshouldbefocusedoncommunicationsactivitiessuchasdevelopmentofmaterialsandcommunication-relatedcapacitybuilding,andonlyinselectedcountries(e.g.,LaoPDR),althoughthecross-borderworkallowedstafftomakeanimpactindiscreteareasinVietnamandThailand,forinstance.ThemalariaworktargetingmigrantworkersinPhuketisagoodexampleofthis,andhelpedtoeducateagroupofformerlyignoredworkerswhowereathighriskofalargelypreventabledisease.ThisworkwastargetedspecificallytoBurmesemigrants,whowereathighriskforacquiringdrug-resistantmalariaand(moreimportantly)goingbacktoBurmaandinadvertentlyspreadingthe

infection.Cambodia,whicheventuallybecamethesiteofsignificantcapacitybuildingrelatedtoinfectiousdiseaseriskcommunicationbythelastyearofMID-BCC,onlycameunderthe(verylimited)purviewoftheprojectafteraseparatebitoffundingwasallottedtohelpaddresscontinuingavianinfluenzaoutbreaksintheKingdom.

Despitetheseconstraints,someofthemainsuccessesoftheMID-BCCprojectwereindengueandmalaria.Eventhoughdengueisoftenaneglecteddisease,thelow-literacymaterialsdevelopedunderMID-BCCandthetrainingtoaccompanytheirusehavemadesignificantinroadsintocontrollingthediseaseinLaoPDR,aswellasamongBurmesemigrantworkersemployedintheloggingindustryacrosstheregion.Infact,preliminarydenguesurveillancedatafrom2011indicatesasharpdecreaseindenguecasescomparedtothepreviousyear.

Moreof thestoryof thesesuccessesistoldinthefollowingsections:Accomplishments in Dengue Control and Prevention (Seepage33);Accomplishments in Malaria Prevention and Control(Seepage37);Accomplishments in Avian Influenza Prevention and Control (Seepage26)andAccomplishments in Emerging Infectious

Diseases (Seepage36).

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MID-BCCbeganbycementingpartnershipsamongkey

playersinacrucialcross-borderarea.Incollaborationwith

USAIDRDMA,theU.N.FoodandAgricultureOrganization

(FAO)andGreaterMekongSubregionResponsestoInfectious

Diseaseproject(GMS-RID),MID-BCCwasinvolvedin

implementingacoordinatedAvianandPandemicInfluenza

(API)workplaninLaoPDRrightfromthebeginning.

FHI360staff focusedoncommunications,whileother

organizations,suchasCAREandtheRedCross,weretasked

withothercomponentsof theworkplan,suchascommunity-

basedoutreach.

Underthiscollaborative-but-stovepipedstructure,itwas

agreedthattheMukdahan–Savannakhet–QuangTricorridor

wouldserveasthefirstpilotsitesforjointactivitiesamongthe

threeorganizations,andaframeworkforcross-borderactivities

alongtheMukdahan–Savannakhetcorridorwasdrafted

withtheinputfromeachproject.

FrameworkforCross-BorderInitiatives

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Research:Mukdahan-SavannakhetBorderArea(LaoPDRandThailand)Workbeganbyusingparticipatoryactionresearchtohelpunderstandwhatpopulationsknewaboutmalaria,dengue,andotherinfluenza-likeillnessessothattargetedandeffectivecommunity-basedcommunicationcampaignscouldbedevised.PARisanapproachthatallowscommunitymemberstoactivelyparticipate,learnfromeachother,andeffectivelyaddressissuesthatthreatentheirlivelihoods,health,andlives.Inthiscase,theresearchaddresseddailylife,includinglivelihoods,culture,andtraditionalpracticesthataffecthealth,determinedcommunicationbehaviorsandpracticesrelatedtohowpeoplesoughthealthcare,andlookedatcommunicationbehaviorsandpreventionpracticesrelatedtoinfectiousdiseases.ThePARtookplaceinfourvillagescomprisedof623householdsofmostlyfarmersandtemporaryemployees.

Aftersomepreparatoryworkthatincludedmeetingwiththepublichealthdepartments,districthealthoffices,andvillageleadersinthestudyareas,MID-BCCconductedaPARtrainingexerciseinMukdahan.MID-BCChelpedtotrain31participants,includinghealthstafffromMukdahanprovincialanddistricthealthauthorities,villageleadersandvillagehealthvolunteers,representativesfromtheProvincialHealthDepartmentofSavannakhet,andGMS-RIDstaff,intheuseofPARmethodology.AfterMID-BCCdeterminedtheresearchquestionsforthePAR(Seeboxonright)andselectedthefourvillagesinMukdahan,professionalcoordinatorsandcommunityfacilitatorswereselectedtoleadtheresearch.ByactivelyincludingthesekeypersonnelinthePARresearchandfindings,MID-BCCgainedbetterinsightandunderstandingofthecommunity’sperceptions,attitudesandpracticestowardsAPI,malariaanddengue.

Savannakhetisahubofcommerce,communication,andmovementofpeoplebetweenThailandandVietnam.PeopleandcarscancrosstheMekongRiverbetweenSavannakhetandThailand’sMukdahan.

LIST OF QUESTIONS FROM THE PAR• Whatisthemainhealthprobleminthevillage?

• Howseriousisthediseaseinthevillage?

• Howdopeoplerecognizethesymptoms?

• Howdopeopleseektreatment?

• Whataregenderrolesregardingcare?

• Howdoesthebridgeaffecttheirlives?

• Howdovillagersprefertoreceiveinformation?Whatmeansandchannelshavetheyusedoften?

• Whatactionsdotheytaketoprotectthemselvesfrominfluenza-likediseases?

• Whatactionswouldtheyconsidertoprotecttheirvillagefrominfluenza-likediseases?

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UsingthePARtools,theprojectwasabletonotonlyoutlinedifferent,potentiallyriskyactivities,butalsopinpointseasonalorannualeventsduringtheyearthatcouldpotentiallysparkadiseaseoutbreak.ThePARalsohelpedthevillagersidentifyactivitiesandbehaviorsthatcouldprotecttheircommunitiesfromdiseaseoutbreaks,andwhichoftheseactionsshouldbetakeninthefuture.

FromthePAR,MID-BCClearnedthatthebordercommunityinMukdahanhadalowriskperceptionofavianandpandemicinfluenza.Iftheyexperiencenasalproblems,Theywillgotothehospitaltodeterminewhichdiseaseitis,butnotuntilsymptomsaresevere.Manyvillagesbelievedthattheseillnessesarecausedbyseasonschanging.

ThisdataidentifiedusefulcommunicationchannelsfordeliveringAPI,malaria,anddenguepreventionandcontrolmessages.Forexample,villagehealthvolunteers,healthcenters,publicaddresssystems,andcommunitymeetingsplayanimportantroleinprovidinghealthinformationinthecommunity.

Italsoidentifiedtimesthatvillagersmightbemoresusceptibletogettingill.Duringtheharvestperiod,forexample,moreLaotiansvisittheirrelativesinThailandorworkastemporaryemployeesinMukdahan,wheretheyaremoreexposedtoavarietyofillnessesthaniftheystayedontheirsideofthebridge.

DuringthePARexerciseinMukdahanthecommunityidentifiedtheissueofdengueasaprioritydisease.Moreover,theMukdahanPublicHealthOfficeindicatedthatthePARhelpedthemtoidentifyissuesthat

theyhadnotpreviouslybeenawareof–forinstance,thatthescarcityofwaterisakeybarriertocompliancewithrecommendeddengue-controlbehaviors.

Afollow-upmeetingwasheldinNovember2011inMukdahanthatincluded45publichealthstafffromtwinnedprovincialhealthanddistrictofficesofSavannakhetandMukdahan.Itwasnotedthatthetwoprovincesactivelyshareinformationbetweentheirhealthdepartmentsonoutbreaksof18diseasesincludingdengue,severediarrhea,pneumonia,typhoid,tuberculosis,HIV/AIDS,andmalaria,andmaintainacommonwebsite.Beyondmerelysharinginformationwitheachother,however,thepublichealthofficialsdeterminedthat,basedonthePARfindings,theyneededhelpwithcommunicatingtheriskofinfectiousdiseasestotheirpopulations.Asaresult,MID-BCCdevelopedacommunicationcurriculumandtrainedLaogovernmentofficials(Seethecasestudythatfollows).

Community members actively participated in the PAR exercise. The above photos show some of the tools being used during the exercise e.g. community mapping and bean quantification.

ThePARalsoprovidedkeyinsightsintothecommunity’slimitedunderstandingofdenguesymptomsandtreatment.Thispavedthewayfordevelopmentofmaterialsondengueandtrainingsofhealthworkersontheiruse.

SeeAccomplishments in Dengue Control and Preventiononpage33.

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Case Study: EngagingCommunitiesintheMonitoringofMarketPricesontheMukdahan,ThailandandSavannakhet,LaoPDRBorderMID-BCChasforseveralyears,collaboratedwithFAOinprovidingacommunicationplatformforlocalcommunitiestoreportpricesandotherinformationthatcontributestoamonitoringsystemthattargetsunusualspikesinmarketprices,indicatingpossiblediseaseoutbreaksinthelocality.TheinterventionisorganizedtocollectmarketdatainfourmarketsinMukdahanandSavannakhet.InLaoPDR,membersfromtheLaoWomen’sUnionthatparticipatedintheearlySMSprojectwererecruited.InMukdahan,withassistancefromthelocalofficeoftheDepartmentofLivestockDevelopment,15marketvendorswererecruitedfortheactivity.

TheSMSinterventionsaredesignedtoberapidandsimpletoparticipatein.Forthemonitoringactivity,threequestionsaresentoutviamobilephoneonaweeklybasis.Thedatasentbackarecompiledinto“flashreports”byMID-BCCandthenthetrenddataanalyzedbyFAO.Thequestionsinclude:

1)Howmuch(THB/LAK)doyoupayfor1kgofslaughteredlocalchickenthisweek?

2)Howmuch(THB/LAK)doyoupayfor1chickeneggthisweek?

3)Howmuch(THB/LAK)doyoupayfor1blackpigletthisweek?

TheprojectcoordinatedwiththeFAORegionalOfficeforAsiaandthePacificandlocalcounterpartsincludingtheMukdahanLivestockOfficeandtheLaoWomen’sUniontorecruitrespondentsintheselectedsitesalongtheMukdahan–SavannakhetCorridor.AllrespondentswereprovidedwithanorientationontheuseofSMStechnologyanditsapplication,andrelevantaspectsofproductsforwhichpriceswerecollected.InSavannakhet,MID-BCCselectedrespondentsfromtheLaoWomen’sUnionwhowerealreadytrainedbytheprojectontheuseofSMSreportingthroughapreviousSMSphonepanelactivity.PricemonitoringviaSMSamongtheseselectedrespondentswascollected,andrawdatawereprovidedtoFAOonaweeklybasisforanalysis.

Right: Orientation on use of SMS provided to vendors in Mukdahan, Thailand

MID-BCC PAR team with community members of selected sites in Mukdahan province.


Collaboration: Champassack–UbonRatchataniBorderAreaBeginninginNovember2011,officialsfromthetwoprovinceswerebroughttogethertorevisitcommunication-relatedactivitiesonH5N1andotherinfectiousdiseases,andtoshareupdatesonpresentthreatsinthecross-borderarea.

Over40publichealthstaffattendedthemeeting,including18districtrepresentativesfromChampassackprovinceinLaoPDRand23districtpersonnelfromUbonRatchataniprovinceinThailand.Underalong-standingMemorandumofUnderstanding(MOU)betweenthetwoprovinces,theyhadagreedtoworkincollaborationtopreventandcontrolcommunicablediseases;exchangeinformationfordiseasesurveillance;andeducatethepublic,amongotherthings.Whattheylacked,however,wascontentforrespondingtoavianinfluenzaandrelatedoutbreaks,andrequestedthatMID-BCCprovidemessages,materials,andtrainingforhowtheirfirstresponderscouldbestarticulatetheriskofthedisease.

OneoutcomeofthiswasthatasessiononriskcommunicationwasheldinLaoPDR,andprovidedanopportunityfortheprovincestoseeandviewvariouscommunicationmaterialsdevelopedanddisseminatedforinfectiousdiseasesincludingH5N1andH1N1.

Research: LuangNamthaBorderArea(LaoPDR,Burma,China)LuangNamtha,aprovincelocatedinthenorthernpartofLaoPDR,isborderedbytheLaoprovincesBokeointhesouthwest,Oudomxayinthesoutheast,byBurmainthenorthwest,andChina’sYunnanprovinceinthenortheast(withthebordercrossingatBoten).Povertyandlivinginremote,mountainousvillageshasmadetheLuangNamthapopulationdifficulttoreachforinterventions–andwithinformation–duringdiseaseoutbreaks.

MID-BCCconductedaPARactivityinLuangNamthainthetwovillagesthatborderChina:namely,BotenMaiandNakham.Theresearchwasenvisionedtogenerateinformationaboutthecommunities’pressinghealthproblems,healthpractices,andhealth-seekingbehaviorsbymonitoringtheirdailylives.Participantsincludedatleast20maleand20femalecommunityleaders,andsimilarnumbersofvillagers.

ThePARrevealedthateconomicissuesweretheforemostconcernoftheparticipants.Theywereworriedabouttheirlivelihoods,andhowtoaugmenttheirincomethroughothermeansbesidesfarming.Healthissuesappearedtobeofnoconcernintheseisolatedfamilies,andtheirhealth-seekingbehaviorswerealmostnon-existent.Notsurprisingly,theseindividualsunderestimatedtheriskofinfluenza-likeillnesses.TheybelievedthatseasonalflunaturallyoccurredduringthecoldseasonfromNovemberthroughJanuary,andthatwomenineachhouseholdweretaskedwithtakingcareofthesickpeopleintheirfamily.Therewasaclearopportunitytoprovidemoreaccurateinformationaboutrisksofinfluenzaandtopromotesaferbehaviorsandpractices.

Below: The village of Boten Mai, seven kilometers away from the China border. Right: Women from Boten Mai participated in the participatory action research in Luang Namtha.

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Research: Bokeo,LaoPDRAPARexercisewasalsoconductedinBokeo–intwovillages,HouayXaiandTonPheung–mostlytocompareresultswithitsneighboringprovince,LuangNamtha.Theprovinceislocatedinthenorthernpartofthecountryandispartofthe“GoldenTriangle”areawhereLaoPDR,BurmaandThailandmeet.HouayXaivillagebordersChangRaiprovinceinThailand,andTonPheungborderstheTachilekdistrictofBurmaandtheChiangRaiprovinceofThailand.

PARactivitiesincludedfocusgroupswith62participants,including22membersfromthevillagecouncils,20femalevillagers,and20malerespondents.InitialPARfindingsrevealedthatthetwovillagesenjoyedpublichealthservicesfromthenearestgovernmenthospitals.Theywerefrequentlyvisitedbyhealthcareworkers,especiallyinHouayXai,wheretherewasnohealthcarevolunteer.Bothvillageswereawareofseasonalflu,andhadheardofbirdflubuthadnotexperiencedanoutbreak.Moreover,fewfamilieshadexperienceddengueormalaria.Inbothvillages,peopleconsideredtheborderahubofprocuringgoodsfromneighboringcountriesandsellingtheiragriculturalproductsandtheirlabor.Cross-bordernetworkingamongthethreecountriesincreasedduringspecialevents,suchasduringboatracefestivalsandtheBuddhistNewYearcelebrationalongtheMekongRiver.Theresidentsnotedthat,forseriousillnessandotheremergencies,theyoftenpreferredtovisitthenearbyThaihospitalsdespitetheirhighercost(comparedtothenationalhospitalsinVientiane).AsinotherLaovillages,womenwerethemaincaregivers,andwhenafamilymemberwassick,mothers/wivesimmediatelybroughtthesickpersontothenearbydistrictorprovincialhospitalformedicalcare.Participantsinbothvillagescouldidentifyserioussymptomsofdiarrhea,dengue,malaria,andseasonalflu.

Theseresearchfindingspointedtotheneedtoenhancethesharingofinformationamongwomenfortheearlydetectionofpossiblediseaseoutbreaks.ThisdiscoverynaturallyflowedintothedecisiontoconsidertrainingmembersoftheLaoWomen’sUniononusingtextmessagingintheearlydetectionofdiseaseoutbreaksintheBokeoarea(SeetheCaseStudy onpage26).

TheinsightsfromthePARalsoledMID-BCCtocontinueprovidingtrainingopportunitiestovillageleaders(i.e.,thevillagechiefandthevillagecouncils).ThePARexercisebroughtawarenessofthelocaldecisionmakinginthecommunity,andmobilizedlocalsupporttoaddresslocalproblems.ThePARalsoledtoadecisiontocontinuetraininghealthvolunteersbecauseeventhoughtheirroleisrecognizedinthecommunity,theyhavefewopportunitiestokeepthemselvesupdatedonhealthissues.

Focus group discussion among male participants in Bokeo.

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Research: RapidAssessmentsinTratandChiangKhong,ThailandIn2010,MID-BCCundertookaRapidEthnographicAppraisal(REA)oftwodiverseprovincesinThailand–ChiangRaiinthenorth,nearBurmaandLaoPDR,andTratinthesouth,whichbordersCambodiaatthetownofHadlek.

REAisamulti-facetedresearchtoolthatconsistedofin-depthkeyinformantinterviews,andfocusgroupdiscussionswithpeopleworkingtocontaininfectiousdiseasesandwithpotentialriskgroups.Italsoincludedon-sitesurveysoflifestylesandlivingconditionsofgroupsatriskfrominfluenza-likeillnesses.Theresulting“snapshot”helpshealthauthoritiesunderstandthesizeandboundariesoftheaffectedareaandtheapproximatesizeofthepopulationatrisk.Italsohighlightssub-divisionswithinaffectedpopulations,suchastransportworkers,migrantworkers,traders,andmarketvendors.REAfocusesparticularattentiononareaswhereresidentpopulationsmixwithmigrant,ormobile,populations.Locationslikemarkets,truckstops,andschoolsarecarefullyevaluated.

AfterconductingtheREA,itwasfoundthat,ingeneral,Thaiandnon-Thaipopulationslargelyliveandworkinthesameareas,exceptinlargefactories,wheremigrantworkersarelikelytobelodgedinfactoryhousing.Socializingisgenerallyreportedtobeamongmembersofthesameethnicgroup,eventhoughThaisandnon-Thaistendtoliveinthesameneighborhoods.Ofallthenon-ThaisthereismoresocializingbetweenLaoandThaisbecauseofthesimilaritiesoftheirlanguages.Inborderareasandinareaswherehilltribesornon-Thaisfromothercountrieshaverelatives,thereissignificantcross-bordermovement,eitherintheformoftradeorfamilyvisits.

Peopletendtomixinmarketplaces,truckstopsandatbordercrossings.MarketsarefrequentedbymanypeopleandarelocatedinmajorcitieslikeChiangRaiandChiangKhong,andalsointownsthroughouttheprovince.Mixinginschoolsdependsontheproportionsofindigenoustonon-indigenouschildrenintheschool-agepopulation.Inneighborhoodswheretherearehilltribemembers,orcitizensofneighboringcountries,

ChiangRaiisamajorinternationalcorridorlinkingThailandwithChinaandVietnamthroughLaoPDR.ItsmainborderpointsareChiangKhongontheThaisideandBokeoontheLaoside.Theeasternpartoftheprovinceconsistsofrelativelyflatriverplains,whilethewesternportionismadeupofhillcountry.

TratProvinceisathinsliveroflandextendingalongtheseatothetownofHadlekontheCambodianborder.ThewatershedfromthecardamomhillsdefinestheThai-Cambodianborder,withflatplainsnearthecoastandhillsclosertoCambodia.TratisalsoborderedbyThailand’sChantaburiProvinceandhastwosignificantoffshoreislands,KohChangandKohKut.ChiangRaiProvincecovers11,678squarekilometerswithapopulationofabout1.3millionpeople.Some220,000ofthosearehilltribe

membersandanother90,000arenon-Thainationals,mostlyfromBurmawithaminorityofLao.

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theyattendschoolwithThais.InChiangKhong,theREAfoundsomemixingatthebordertruckstop.Truckssometimesstopovernightwiththedrivers’wivespreparingameal,orwithtruckdriversvisitingfoodstallsorrestaurantsnearthebordercrossing.Truckdriverstendtosleepintheirtrucks,notinhotels.

MalariaanddengueemergedintheREAasdiseasesofconcerninbothprovinces,withmalariatoppingthelist.SeveralpeoplewhoparticipatedintheChiangRaifocusgroupdiscussionssaidthatmalarialmosquitoespreferrunningwaterandthatthosecarryingdenguepreferstillwater,whichtheybelievedexplainswhymalariaisfoundmoreinthecountrysideanddenguemoreinthecities.

FGDparticipantsinbothprovincessaidthatforestworkerswereathighriskformalaria.InTrat,manyplacesarejustafewkilometersfromwildordomesticatedforests.Forestworkerscommonlystayintheforestsafternightfallandarefarlesslikelytousebednetsorotherpreventionmethodstoprotectthemselvesfrombitinginsects.Bordersoldierswerealsoconsideredvulnerable,becausetheyoftenstayintheforestsatnightwithoutanyprotection.

Non-Thaiswereconsideredtobeathighriskingeneral.InTrat,thatincludedmostlyCambodiansandBurmese,whileinChiangRai,thepopulationsofconcernwereCambodians,Lao,andhilltribemembers.Thesegroupswereseenasbeingatgreaterriskbecausetheytendtobepoor,toworkmoreofteninforestareas,andtobemoreincontactwithcountrieslessprotectedfrommalariaandwithlessaccesstohealthcare.

Thegenerallevelofawarenessaboutdenguewasmuchlowerthanformalaria.Peoplewereawarethatdenguewasadanger,buthaddifficultynamingspecificriskgroups,otherthantosaythattheyseeitasadiseaseofthecitiesortheplains.

Mostnon-hilltribepeopleinChiangRaiknewthatbothmalariaanddenguearetransmittedbymosquitobites.Somehilltribepeoplestillbelieveinnon-scientifictheoriesofdiseasetransmission.Amongnon-hilltribepeople,denguewasagreaterconcernthanmalariaandmanypeoplebelievedmalariahadbeeneliminated,thoughtheystilltookprecautionstopreventbeingbitten.InTratthemajorityknewthatmosquitoestransmitmalaria,althoughtherewereafewwhobelieveditistransmittedthroughdrinkingwater.Mostpeoplealsobelievedthatdengueistransmittedbymosquitoes.


SuggestionsmadeintheREAfocusgroupscalledforbroadeningcurrentpreventionefforts.ManyFGDparticipantsproposedthatpreventionprogramsshouldemphasizethefollowingactivities:

• Eliminatemosquitoesbyinsideandoutsidespraying

• Protectagainstmosquitoesbyusingbednets,lotions,creams,fans,andscreens

• Improvecommunicationwithnon-Thaisbytranslatingmaterialintotheirlanguages

• Improvehealtheducation,includingoutreachandprevention

• Usevillagehealthvolunteersforprevention

• Improvesurveillancebyincludingteachersinthisactivity

• Makesurethatvisitorsfromhigh-riskareasaretestedandtreated

Overall,REAparticipantssaidthatvillagehealthvolunteersandagentsoftheMalariaServicearetheirmosttrustedsourcesofinformationregardinginfectiousdiseases.InseveraloftheFGDs,participantssaidthattheytrustedothermembersofthesamecommunity,whichcouldindicatethatcommunitymobilizationwouldbeaneffectivemeansofcommunication.Itwasalsosuggestedthatbehaviorchangecommunicationshouldbeaimedathigh-riskpopulationsandshouldfocusonspecificinfluenza-likeillnesses.

Becauselanguageissuchanimportantpartofcommunication,theREAmadeitclearthat“atriskgroups”whodonotspeakorreadThaineedtohaveaccesstoimportantpointsaboutdiseasepreventionandtreatmentintheirnativelanguage.Gettingthemessageacrosstonon-Thaispeakerswasviewedasparticularlyimportantbecausegroupsspeakingotherlanguageswereseenasbeingathigherriskofcontractingtheillnesses.Reducingprevalenceamongthemwouldreducetheriskforall.

Thesefindingscontributedtodecisionstofocusonmigrantworkersineducationeffortstopreventmalariaandotherinfluenzalikeillnesses.(SeeAccomplishments in Malaria Prevention and Controlonpage37)

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Research: BurmeseMigrantWorkersinPhuket,Thailand

DuetothehighriskofmalariainthetouristlocaleofPhuketinThailand–anditshighnumbersofmigrantworkers–itwasdeemedimportanttoassessknowledge,attitudesandpracticesofmigrantBurmeseandlocalThaipopulationsonmalariaandotherfeverproducingillnessessuchasinfluenzaanddengue.Basedonthoseresults,materialsweredevelopedtoassessandeducatebothmigrantworkersandlocalpopulationsonhowtopreventmalaria,recognizeitssymptoms,andunderstandhowtotreatit.

In2010,MID-BCCundertookaKAPsurveyofmigrantBurmeseandlocalThaisontheThaiislandofPhuket.ThegovernmentofThailandhadselectedPhuketasapriorityareaformalariaelimination.Thesurveyfocusedontheirknowledge,attitudesandpracticestowardmalariaanddengue.

Thailandisalow-impactcountrywhenitcomestoinfluenza-likeillnesses,suchasmalaria,dengue,andinfluenzas.However,inareaslikePhuket,influenza-likeillnessescanflareupbecauseoftheinfluxofmigrantswhomaybelessawareofthesymptomsoftheseillnessesandlessabletogetmedicalattention.Registrationstatusandaccesstoinformationthroughthemediaarealsopotentialbarriersfacingmigrants.

BecausePhuketisamajortouristdestination,itattractsalargenumberofmigrantworkersfromBurma.Asidefromthetouristindustry,theyworkaslaborersatthemanydevelopmentsaroundtheisland.Fishingandrubbertappingarelabor-intensiveindustriesinPhuketthatalsoattractmanymigrants.Becausealargeproportionof

migrantworkersareunregistered,theyareineligibleforhealthcarecards,thusreducingtheiraccesstomedicalcare.Thisleavesthemvulnerableshouldtheycomedownwithanytypeofillness.

MIGRANT WORkER RISk ASSESSMENTAroundPhukettheforestedhillsareparticularlyriskyareasbecausethemalariamosquitobreedsandthrivesthere.Alsoofconcernarethethreeindustrieswheretherisksofexposuretoinfluenza-likeillnesses(ILIs)aregreatest.ThepeopleselectedtoparticipateintheKAPsurveyweremadeupofmigrantsfromeachoftheseindustriestoensureabalancedrepresentationofthemigrantpopulation.GroupsfromallvulnerableprofessionswereselectedandthefinalgroupofpeopleinterviewedwasweightedtoachievearepresentativegroupofmigrantsinPhuket.Boththeindustryinwhichtheyworkedandthelevelofmalariatransmissionrisktheyfacedweretakenintoconsideration.

MID-BCCworkedincooperationwiththePhuketProvincialHealthOffice,theKenanInstituteAsia,andWorldVisionPhukettoidentifyandinterviewKAPparticipants.InThaihouseholdsafamilydecision-makerforhealthprotectionissueswasinvitedtoparticipate.IntheBurmesemigrantgroup,respondentswereselectedatrandomfromwithinpre-determinedcampsbasedonalistfromthePhuketMalariaUnit.Theinterviewswereconductedinthecampsandvillageswherethepeoplelived,whichalsoofferedavisualcheckofthesurroundingconditions.

Thestudywasdesignedtoprovidevitalinformationaboutthesymptoms,transmissionroutesandactionsthatneedtobetakentoblockthetransmissionofillnesseslikemalaria,denguefever,H5N1avianinfluenzaandH1N1swineflu–exactlythekindinformationthathealthprogrammersneedtodesignsuccessfulbehaviorchangecommunicationstrategies.


LEARNING TO COMMUNICATE EFFECTIvELy Whentryingtocommunicatewithvariousgroupsofmigrantsaboutinfluenza-likeillnesses,ithelpstousetherightlanguage.TheKAPsurveyincludedextensivein-depthquestioningbyinterviewerswhospokethenativelanguageofthepeoplebeinginterviewed.Manyofthequestionsfocusedonthemediaandwhichhasthehighestpenetrationandusageamongvulnerablegroupswhenitcomestohealth-relatedinformation.Interviewersalsoaskedaboutthepotentialtousemobilephonesforhealthcommunication.

TheKAPsurveysoughttoestablishwhatchannelsofinformationarebestwhencommunicatingaboutinfluenza-likeillnesses.Itlookedatothercriticalsocial-networkinginformationlikewhatpeoplerememberaboutpastandcurrentcommunicationactivities.Thepeopleinterviewedwereaskedtotalkabouttheirviewsoncommunicationtoolslikepublicserviceannouncements,TVprograms,radio,localeventsandgovernmentandnongovernmentalcampaignsandcommunicationprograms.

WHAT THE kAP SURvEy DETERMINEDTheliteracyrateamongtheThaicommunitiessurveyedinPhuketapproached100percent,withmosthavingajuniorhighschooleducation.AmongregisteredmigrantsworkinginPhuket,morethan72percentcouldspeakThai,butonly1percentofthemwereabletoreadThai.Ontheotherhand,unregisteredmigrantworkersearnedlessthan10,000THBpermonthandonly53percentofthemcouldspeakThai.Morethanhalfhadonlyanelementaryschooleducation.

Thaiswereverymuchawareofinfluenza-likeillnesses,especiallydengueandpandemicinfluenza.Theirknowledgeaboutsymptoms,transmissionroutes,andhowtoblocktransmissionwasreasonablyhigh.But,theirknowledgeaboutmalariawassomewhatweakerandtheywereconfusedabouttherisksassociatedwithday-timeandnight-timemosquitoes.

Notallthemigrantswereawareofinfluenza-likeillness(ILIs),andthismeansthatbydefaultsomeareatrisk.Apartfrommalariathereweresomeclearknowledgegapsinrelationtosymptoms,transmissionroutes,andhowtoblocktransmission.TheyalsodemonstratedsomeclearmisconceptionsaboutILItransmissionroutesand,liketheThaistheyalsowereconfusedaboutday-timeandnight-timevectors.

Thaihouseholdskepttheareasurroundingtheirhomesfreeofwater-collectingcontainers.Becausemigrantslivenearthecamps,ontheotherhand,theyfaceacertainamountofriskthatvectorswillbepresent.Whilethemigrantsalsokeeptheirimmediatesurroundingsfreefromwater-collectingcontainers,morethanhalfthecampshaveanabundanceofsuchcontainerslyingaroundelsewhereand,insomecamps,garbageisleftaccumulating,creatinganenvironmentwherepotentiallyharmfulvectorscanthrive.

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THE RISkS OF CONTRACTING INFLUENzA-LIkE DISEASESAlmost30percentoftheThaissurveyedriskedexposuretomalaria-carryingmosquitoesbecausetheyusedneitherwindowscreensnorbednets.TheThaicommunitiesinthevicinityofmigrantcampswereatsubstantialriskofexposuretoharmfulvectors.Some40percentofThaissurveyedsaidtheydonotusewindowscreensornetsonaregularbasis.Theprevailingattitudewasthattheydonotneedthem,whichwouldindicatesomemighthaveafalsesenseofsecurity.Duetotheconfusionbetweenday-timeandnight-timemosquitoes,manybelievednetshelpedtoprotectagainstdengueandsotheyseldomusedinsectrepellent.

TheThaisinthesurveycookpoultrythoroughlyandwashtheirhandswithsoap,buttheyarestilllikelytosneezeintheirhands(ratherthanintotheirarm)andthisoffers

virusesaneasymeansoftransmission.Overall,migrantbehaviorissimilartoThaibehavior,butone-thirdwasnotawareofpandemicinfluenza,whichwouldindicatethatmanydonotknowhowtoprotectthemselves.Moretroublingstillwasthediscoverythatnearlyeverycamphadfree-rangepoultry,raisingtheriskofavianflu.

Althoughmigrantsdonotusewindowscreens,mostusenets,therebyreducingtheirriskofexposure.Ontheotherhand,theymaybemorefrequentlyexposedtodangerousvectorsbecauseoftheirjobsandthefactthattheyspendalotoftimeoutside.Unregisteredmigrantsusenetstoalesserextent,increasingtheirriskofexposure.Evenmigrantswhoarenotawareofmalariausenetsandthenetsareninetimesoutof10ingoodcondition.So,whiletheydonotmaketheconnectionbetweennight-timemosquitoesandmalaria,moststillprotectthemselves.

BEST CHANNELS OF COMMUNICATIONThereisadistinctdifferencebetweenmigrantsandThaiswhenitcomestothemedia.Oneinthreemigrantsdidnothaveaccesstoanymedia.Thebestwaytocommunicatewithsuchpeopleisthroughhealthcareworkers,wordofmouth,ormorereliablystill,throughtheiremployer.ThegeneralmediaconsumptionpatternforThaisandmigrantswasaboutthesame.Theywatchedtelevisionatnightbetween6p.m.and9p.m.,whileradiowaslistenedtothroughouttheday,withsomepeoplelisteningontheirmobilephones.


MobilephonepenetrationwasveryhighamongThais,at93percent.Itwasalsosurprisinglyhighamongmigrants,withnearlytwointhreemigrantsinpossessionofaconnectedmobilephone.MigrantsalmostexclusivelyusedDTAC,becausethemobilephonecompanyoffersreducedcallratesbetweenphonesusingitsnetwork.Apartfrommakingandreceivingvoicecalls,peopleuseSMSmessaging,Bluetooth,andlistentotheradioontheirmobilephones.Theusagepatternformigrantsissomewhatlower,whichcouldbeduetocostfactors.ThemaindifferencebetweenmigrantsandThaisisthatmigrantsrelymoreoninformalmedia,possiblybecausetheyhaveaccesstofewermediasources.

TheKAPinterviewsprovidedclearindicationsofhowtocommunicatewithvulnerablepeopleinPhuket.ForthelocalThaipopulation,itisthroughmainstreammediawithpublicserviceannouncements.Theprimaryapproachwouldbetheuseoftelevisionwithmessagesscheduledforlateafternoonandeveningandmorefrequentmessagesdeliveredoverradiointhemorningandatlunchtime.

KAPresultsindicatedthatmigrantscannotbeaseffectivelyreachedthroughmainstreammediaasThais,buthealthinformationcanstillreachthemwheretheyliveandwork.ThefactthatmigrantsfromBurmaarecloselynetworkedwitheachotherisapotentialadvantage.AlternativemedialikeSMSmessagingcouldbuildonthisandcreatea‘viralcampaign’throughhumaninteraction.

AswiththeotherresearchconductedunderMID-BCC,thesefindingswereusedtoinformcampaignstoeducatemigrantsandThaisonhowtopreventmalariaandotherinfluenza-likeillnesses(SeeAccomplishments in Malaria Prevention and Controlonpage37).

Research: SupplyChainActorMappingAlongtheMukdahanCorridoracrossThailand,LaoandVietnamMID-BCCstudiedthevariousactorsalongthesupplychainoftheMukdahanCorridor,whichspansThailand,LaoPDRandVietnam.Theresearchwasintendedto:exploretriggersandbarriersofpreventivebehaviorincommercialactorswithinthesupplychain;identifyriskareasandgaininsightintopossibleinterventionstrategies;andrecognizeandprovidereasonsforweaknessesinbiosecurityandpreventivebehavior.Thestudywasconductedatfoursites:MuangMukdahanDistrictinThailand;KhanthaboulyDistrictandSeponeDistrictinLaoPDR;andHuongHoaDistrictinVietnam.

Themappingexerciseresearchedcommercialfarmers,contributorsandopinionleaders,andwasinpartbasedonthehealthbeliefmodel:inotherwords,healthbehaviorsareexplainedandpredictedbyfocusingontheattitudesandbeliefsofindividuals.Anindividualwillactiftheyperceivethatthereisanavoidablethreatandiftheyhavethemeanstotaketheappropriateaction.Differenttypesofbarriersmayoccurateachstageandthefocusofthecommunicationinitiativeshouldbeadjustedaccordingly.

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Thestudyfoundseveralpotentialdangerroutes,orweaklinksinthesupplychainalongtheMukdahancorridorthatmayresultintransmissionofAI.Theresearchalsonotedthatopinionleadersineachcountryhaveanimportantroletoplayintermsofsupportingcommunicationactivitiesandotherinitiatives,andthattheseindividuals(andthemessagestheywouldbedeliveringandsupporting)wouldvarydependingonthecountry.

Thereweredifferentlevelsbiosecurityandpreventivebehaviorsinthesupplychaindependingonthecountry.Overall,Vietnamhadarelaxedattitude,withnorecentAIoutbreaksandagovernment-mandatedanimalquarantineandvaccinationpolicythatfosteredcomplacency.LaoPDRwasinthemiddle,andaimedforbetterbiosecuritybecausemanyofthesupplychainactorsrememberedthelastoutbreakandwantedtoavoidarepeat.Thailandhadveryhighbiosecurity,perhapsbecauseitiscontrolledmorebylargefoodcompaniesthatintroducedstrictpractices.

Asnoted,Vietnamactorsexhibitedafalsesenseofsecuritybasedontrustinthecountry'svaccinationandquarantinesystem.OnewaytoaddressthiswouldbetoworkwiththegovernmentonotherdiseasepreventionprogramsthatwouldhelptopreventAI.Forexample,NewcastlediseasepreventionisapriorityforfarmersanditspreventionhelpsinthepreventionofAI.InLaoPDR,actorsarenoteconomicallydependentonpoultry–anditmaynotbeworththeirwhiletoinvestinbiosecuritymeasures–butneverthelessneedtobeconcernedduetorecentoutbreaks.Toaddressthisbarrier,transportworkersmightbeeducatedbecausepoultryarestoredascargoonthesamebustransportsystemsusedbyhumans.InThailand,thereisstrongrelianceontheexistingsurveillancesystemandconcernislow.Therefore,itmightbeworthwhileforthesurveillancesystemtoincludeborderactivities,particularlythebiosecurityofpoultrytransportedfromLaoPDR.AswiththeotherresearchconductedunderMID-BCC,thissupplychainmappinghelpedtoinformandfeedintovariousinterventions,suchasreachingouttopotentiallyat-riskpopulationswheretheywork,live,learn,andgather(e.g.,festivals).


Reflectingontheaccomplishmentsof theMID-BCCproject–strengthening

thecapacityof differenttypesof communitiestoeducatethemselvesand

othersabouttherisksof infectiousdiseases–itisclearthatthepillarsof

boththeGlobalHealthInitiativeandthecomponentsof USAIDForward,

thedonoragency’srecentlylaunchedreforminitiative,arewoventhroughout

theproject’sactivities.Insomecases,thiswasintentional–e.g.,working

withtheLaoWomen’sWomenensuredbothanorientationtowardwomen’s

empowermentandcontributedtolong-termsustainabilitybystrengthening

along-establishedinstitution,bothprongsof theGlobalHealthInitiative.

Inothercases,thisconvergencewasinadvertent(butserendipitous),as

Accomplishments


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USAIDForwardwasnotevenannounceduntilthelastyearof theproject’s

existence.Inmanyways,USAIDForwardinstitutionalizestheGHI,creating

departmentstooverseeandfocusonevidence-baseddevelopmentpolicies,

knowledge-sharing,andevaluation;aswellasputtinginplaceastructurefor

fosteringinnovativedevelopmentsolutionsthathaveabroadimpacton

people.Evidence-based,sustainableinnovationswereachievedunderMID-

BCC,asoutlinedinthenextpartof thisreport:intheareasof avianinfluenza

preventionandcontrol;indengue;inmalaria;andinthecapacitytoaddress

emergingandestablishedinfectiousdiseasesacrosstheboard.


AccomplishmentsinAvianInfluenzaPreventionandControlBuildingonthesuccessofpreviouscollaborationswiththeLaoWomen’sUnionundertheAI-BCCproject,MID-BCCcontinuedtostrengthenthecommunicationcapacityoftheseindustriouscommunitymembers.Thistimearound,mobilephonetechnologywasusedincommunityoutreachandmobilizationactivities,primarilyaimedatreducingtheriskoftheH5N1virus(SeetheCaseStudythatfollows).

Case Study:EngagingtheLaoWomen’sUniontoAvertInfectiousDiseaseOutbreaksviaInformationSharingAspartofevaluatingdifferentrapid-responsemechanismstocontainoutbreaksofavianinfluenzaintheMekongregion,MID-BCCrealizedthattheLaoWomen'sUnion’s(LWU)capacitytoconductcommunityoutreachandmobilizationduringdiseaseoutbreaks(includingH5N1virus,malaria,anddenguefever,aswellaspandemicinfluenza)couldbefurtherstrengthenediftheywereintroducedandtrainedontheuseofSMStechnology.

MID-BCCsetuparapidresponsemechanismwithLWUtomonitorpublichealthinitiativesincross-bordersitesinandaroundfourprovincesincludingVientiane,Savannakhet,LuangNamtha,andBokeo.TheprocesswastoinitiallytrainagroupofMasterTrainerswholivedinthesefourprovincesandwerealsomembersoftheLWU.They,inturn,wouldgobacktotheirprovincesanddistrictsandtrainadditionalunionmembersonhowtorecognizeandthengatherinformationonpublichealthinitiatives,andthenreportonthembyrespondingtoaseriesofquestionsprogrammedontheirmobilephones.Thiswouldenabletheprojecttonotonlymonitoranimaldeathsandcasesofsickanimals,butalsotogaininsightsintohealth-seekingbehaviors,uncoverthebestformofsupportforaddressinghealthproblems,obtainfeedbackonwhatsupportmaterialsaremostuseful,andunderstandcurrenthealthreportingpractices.

Panelparticipantswererecruitedfollowingcarefullypreparedscreeningcriteria,includinghavingageneralpacketradioservice(GPRS)-enabledmobilephone.Atotalof17panelparticipantswererecruitedandtrainedinitiallytobecomeMasterTrainers.TogetherwithaPanel


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CoordinatorfromtheMID-BCCProject,theMasterTrainers,inturn,conductedadditionalrecruitmentintheirrespectiveareas.Atotalof71participantswererecruitedandsuccessfullyregisteredonthepanel.Thetrainingguideconsistedoffivesessions:Brainstormingaboutinfectiousdiseases;theroleofLWUmembersinemerginginfectiousdiseaseissues;themechanicsofthemobilephonepanel;recruitmentofSMSpanelists(fortrainers);andoversightofmobilephonepanels.

TheProgramsetupawirelessapplicationprotocol(WAP)-basedsystemwherepanelparticipantscouldreportdirectlyviaaGPRSinternetconnectionusingtheirownmobilephones.Whentheparticipants’mobilephoneshadbeensuccessfullyconnectedtotheinternet,theyhadtoregistertothepanelonlineandcompleteatestsurvey.AscheduledSMSlinkwassenttoeverypanelmemberonaweeklybasisforfourtosixweeks.ThelinkleduserstoaWAP-hostedsurveythatincludedonetosixquestionsinthelocallanguage.

Dataweresubmittedstraightfromthephonetoafinaldatabase,enablingthecollectionofdataanywheretherewasmobilephonecoverageandGPRSavailable.Alldatasubmittedbypanelparticipantswasmonitoredthroughanonlineadministratorsite,whichalsotrackednon-respondersandpotentialdrop-outsacrossallpanelmembers.

Eachwaveofdatacollectionwasdevotedtoeitherhumanoranimalhealth.Inthehumanhealtharena,theLWUisinvolvedwithanumberofactivities,rangingfromprovidingbasichealthinformationtolocalfamilies,toassistingthedistricthealthoffice.Theysupportlocalcommunitiesandlocalhealthcarepersonnelwithdisseminationofinformationandeducation,andalsoengageinlocalmediacampaignsandmediabroadcasts.

BecausetheLWUmembersarefamiliarwithobservingvariousdiseasesymptoms,itwasdeterminedthattheLWUcouldpotentiallyplayaroleinregulardiseasemonitoringusingSMS.

Inanimalhealth,theLWUareinvolvedwithanumberofdifferentactivities.Theyprovideanimalhealthinformationtothelocalcommunity,andcoordinatewiththegovernment’sDistrictAgricultureandForestryOffice(DAFO).Observationofsickanddeadanimalssuchaspoultry,pigs,andbuffalosiscommon,butevidencesuggestedthatmanyofthecasesarenotreportedthroughformalchannels,whichmeansthatpotentialinfectionscouldgounnoticed.

Itwasinitiallyexpectedthatthetotaldrop-outrateofpanelparticipantswouldbebetween10-15percent.However,itturnedouttobemuchhigherthanthisduetophonecompatibilityandparticipantcapacityissues.Severalserviceprovidershadtobeused,asmobileinternetservicesvarybylocation.InternetconnectivityisachallengeinLaoPDR,butovertime,panelmemberslearnedtorecognizewhentheyhadagoodsignalandtotimetheirresponsesaccordingly.

LWU Members at Training


MID-BCCalsousedadvocacyandparticipatorymeetingstofurtherstrengthentheabilityofLWU,othercommunityleaders,andgovernmentleaderstorespondtooutbreaksofavianinfluenzaandsimilardiseases.

Inmanycases,itbecameclearthattherewasaneedtoeducateandadvocateforincreasedattentiontoavianinfluenzaoutbreaks,andtohelpmakethecasethatpreparingfor,preventingandcontrollingoutbreaksofavianinfluenzawouldhelptopreventcontroloutbreaksofawidevarietyofinfectiousdiseases.TheMID-BCCprojectsettoworkonanadvocacytrainingguideto

InThailand,34peoplefromtheThaiMinistryofPublicHealthandMinistryofNaturalResourcesandEnvironmentwereguidedthroughthetraininginJuly2012sotheycouldlearntoplanandimplementanadvocacycampaignthroughlearningsessions,videoexamples,andacasestudy.Usingthecasestudy,participantsdevelopedadvocacyplans,segmentedaudiences,identifiedinfluentials,preparedspokespeople,designedmessages,filmedpressstatements,andthencollectivelycritiquedandrevisedtheirwork.Thetrainingunderscoredtheimportanceofasystematic,plannedandevidence-basedapproachtocommunication.Intheend,thetwoministriesexpressedinterestinfuturetrainings,suchasspokespersontrainingforhigh-levelministryexecutivesandriskcommunicationtrainingformid-levelofficials.

TheadvocacyguidewasalsousedinwithgovernmentofficialsinLaoPDR.Pleaseseetheblogpost“Learning Advocacy: Building from What is Known to Unknown”onpage50thatrelatesanexperiencefromoneofthefirstadvocacyworkshopsheldinLaoPDR.

helpstakeholders.Called“Subtle Persuasion: An Easy and Effective Handbook for Changing the World through Advocacy,”theguidewasusedfortrainingsfortheThailandMinistryofPublicHealthandothergovernmententitiessuchastheDepartmentofWildlife,andtheLaoPDRGovernment.Theguideisstructuredtobeusedforavarietyofissues,notjustavianinfluenza,asawaytobuildadvocacyskillsandknowledgeamongtrainingparticipantsonhowtocommunicatetheircasetopeoplewhocanhelpmakeadifference.Theday-longtrainingincludesinteractiveactivitiesandsmallandlargegroupdiscussions.Facilitatorsareencouragedtoadaptorrevisethecurriculum,asnecessary,tomeettheadvocacychallengesintheirspecificcountryorfortheirspecificissue.Componentsofthetrainingincludeafacilitator’sguide,anaccompanyingPowerPointpresentation,handouts,andatake-awayguideforeachparticipant.

Communityleaderswerenotalwaysvillagechiefsorpublichealthofficials.InCambodia,forexample,MID-BCCequippedBuddhistMonkswiththeskillsandinformationtoimpartavianfluinformationtopeopletheycameincontactwith.


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Everyyear,CambodianmonkspartakeintheDhammayietra,apeacewalk.In2012,MID-BCCprovidedthemonkswithmaterialsandinformationonhowtopreventavianinfluenzatodisseminatetotheschoolsandcommunitiestheyvisited.Theprojectalsoeducatedandtrainedthemonksonhowtoprovidethisinformationtothepeopletheyencounteredalongtheway.

Theprojectfirstrecruitedagroupof10monkswhowouldserveasmastertrainers,andeducatedthemonH5N1transmissionandhowtopreventit.Theworkshopprovidedthemonkswiththeskillstoconducttheirowntrainingsessionswithothermonks,andreinforcedbirdflumessagesandhandwashingtipsthatthemonkscoulddemonstrateduringtheirannualDhammayietra22WalkinthedistrictofSamraongandfivecommunesinOddarMeancheyProvince.Followingthetrainingsession,eachofthemonksreceivedboxesofsoapbarswithH5N1messagesonthemthattheycoulduseinfuturetrainingsandtheWalkinMarch2012.Theblogpost“Dhammayietra 22: Avian Influenza prevention during the annual monks' peace walk in Cambodia”onpage56providessomeof thebackstoryof thiseffort.

Indeed,connectingwiththecommunityduringtheseopportunisticmomentswasahallmarkoftheMID-BCCproject:toreachpeoplewithinformation,youcannotexpectthemtocometoyou.Youhavetogotothem.

InLaoPDR,thiswasatimportantculturalevents,suchastheThatLuangFestivalinVientianeCapital,andtheBoatRaceFestivalinChampassack.InformationalprogramswerealsoairedonLaoTVandoutreachwasconductedinoneofthecentersofLaoeverydaylife:themarket.Theblogpost“Revisiting the markets in Lao PDR: Avian Influenza Risk Reduction Campaigns before the Pi Mai” onpage46outlinessomeobservationsrelatedtoreachingouttothecommunitytoreducetheirriskofcontractingavianfluwheretheyworkandshop.

InCambodia,inadditiontousingthemonksontheirPeaceWalk,communitymeetingsalsohelpedtogetthewordout.

RISk COMMUNICATION CAPACITy BUILDINGCommunicatingriskisoftenacomplicatedendeavor.Tohelppeoplegetthemessageacrosseffectively,MID-BCCtrainedeightmembersoftheCambodianrapidresponseteamonriskcommunicationinJune2012,withtheideathattheseindividualscouldthentrainprovincialanddistrictteammembersandbetterenhanceCambodia’scapacitytorespondeffectivelytoaH5N1outbreak.

Whenitcametimeforthetrainingstomovetothelocallevel,thetrainerscamethroughwithflyingcolors.Overall,morethan200peopleweretrainedinfourprovinces.

Seethetwoblogs“MID-BCC in Cambodia: Training the Frontlines on Risk Communication”(onpage66)and“High Risk Communication Training in Battambang, Cambodia”(onpage76)thatdemonstratetheeffectoftheriskcommunicationsessionsontheparticipantsfromKampongSpeuandBattambang,Cambodia.


DID ALL THIS TRAINING AND OUTREACH MAkE A DIFFERENCE?Afinalevaluationwasnotconductedonprojectactivities,butseveralevaluationswereconductedinmid-streamtogaugewhetherMID-BCC’seffortswerehavinganimpact.

Between2009and2011,MID-BCCtrainedover500healthworkers,communityleadersandotherstakeholdersatthedistrictlevel.Butdidallofthistrainingleadtomeasurableprogressandincreasedknowledgeamongtheseindividuals?Toanswerthisquestion,animpactevaluationwasundertakentomeasuretheeffectivenessofthetrainingsandtocaptureanycommunicationactivitiesthatwereconductedasaresult.Specificobjectivesfortheimpactevaluationwereasfollows:

• Determinewhethertrainedcommunityorvillageleadershaveconductedrelevantcommunicationactivitiesatthecommunelevel;

• Identifyactivitiestrainedcommunityorvillageleadersaredoinginrelationtodifferentinfectiousdiseases;

• Identifytheextenttowhichmessagescommunicatedhavebeenfocusedonplanning,preventionandresponsetoinfectiousdiseases;and

• Identifyissuesorproblemsfacedinconductingtheseactivitiesandhowtheyhaveovercometheseproblems.

MID-BCCsurveyed272peopletrainedbetween2009and2011,selectedfromparticipantlistsprovidedbyFHI360.Mostoftherespondentswerehumanhealthworkers,followedbyvillageleaders,membersoftheLWU,provincialofficers,andanimalhealthworkers.

TrainingPerformance

Tomeasureoveralltrainingperformance,atrainingperformanceindex(TPI)wascreated.TheTPIwascomprisedofrespondents’assessmentofoverallperformanceofthetrainingactivity(fromweaktostrong),whethertheywouldrecommendittoothers,whethertheywouldparticipateinasimilartraininginthefuture,anditscomparativeusefulness.TheoverallTPIforthe2009trainingswas108outofahighestpossiblescoreof120,andincreasedto114fortrainingsconductedin2011.Mostofthepeopleinterviewedweretrainedin2011(63percent).

Malesgavethetrainingshigherscoresthandidfemales,andolderparticipantsseemedtoscorethetrainingshigherthanyoungerones.Comparingrespondentsbytheiroccupation,thehighestscorescamefromanimalhealthworkersandvillageleaders;membersoftheLWUprovidedthelowestscores.Acrossregions,themostdistinctdifferenceswerebetweenlocationsinThailand,wherescoreswerelowerthantheywereatsitesinLaoPDR.Comparingscoresbygovernmentlevel,itseemedthattrainingswererelativelymoreappreciatedatthevillage

After being in training,

virtually all of the participants

(97 percent) took action related

to disease prevention, planning

or response.


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levelcomparedtothecentralprovinceanddistrictlevels.Bydiseasestate,theparticipantsinavianinfluenza-focusedtrainingsweremoresatisfiedthanparticipantsinsessionsfocusedondengueormalaria.

Whilethetrainersandtrainingmaterialsusedweregivenhighratingsonaverage,severalaspectsoncontentwerelowerinrelativeterms.Oneinterestingfindingwasthat“abilitytoimplement”scoredabelow-averagerating.Asaresult,itmightbeworthconsideringshiftingthetrainingcontenttofocusmoreonimplementationtoaddressthisconcern.

TrainingOutcome

Virtuallyalloftheparticipants(97percent)havetakensomeactionrelatedtodiseaseprevention,planningorresponsefollowingthetraining.However,theproportionofparticipantswhohaveengagedinthesetypesofactivitiesonaregularbasis(i.e.,onceormonthormore)wererelativelyfew(17percent).Animalhealthworkersandthoseatthevillagelevelhaveengagedindiseasecommunicationactivitieslessfrequentlythantheotherrespondents.

Onaverage,participantsengagedintwotothreeactivities.Groupdiscussionsandclubmeetingswerethemostcommonactivitiesundertaken(68percent),followed

Malaria Prevention 27 %

Planning for Dengue 24 %

Planning for Malaria 19 %

Response to Dengue 21 %

Response to Malaria 16 %

Al Prevention

Dengue Prevention 29 %

Planning for Al Outbreak 74 %

Response to Al Outbreak 61 %

byputtinguppostersorstickers(47percent),distributingbooklets(42percent),visitinghouseholdstotalkabouttheissue(36percent),conductinganorganizedtraining(35percent),changingone’sownbehavior(32percent),promotingtheissueatcommunitygatherings(23percent),andinfluencingpeopletheyknowtochangetheirbehaviors(19percent).

Thetargetsforcommunicationactivitiesextendedacrossthreetiers:communicationaboutdiseasestoimmediatefamilyandneighbors(justover90percentdidthis);topeoplefromthesamevillage(justunder50percentcommunicatedtothislevel);andtosupplychain,districtofficersandagents(onlyabout20percentofrespondentsdidthis).Clearly,thelevelofeffortrequiredtocommunicatetothelattergroupwashigherthanwasneededtocommunicatetofamilyorneighbors.

Withregardtocommunicationmessages,adistinctionwasmadebetweenmessagesthatfocusedonresponse,planningorprevention–inotherwords,participantswhocommunicatedaboutmalariamighthavecommunicatedonlyabouthowtopreventmalaria,andnotnecessarilyhowtorespondtoit.Thegraphbelowillustratesthebreakdownofthetypesofmessagesdelivered.

TyPES OF MESSAGES DELIvERED


58

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10075

100

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17

Disease ApplicationAIDengueMalaria

AI Training Malaria Training Dengue Training

87 %

However,participantswentbeyondthefocusoftheirparticulartrainingandappliedwhattheylearnedtootherdiseasesaswell.Forexample,thosewhoparticipatedintrainingformalariaordenguehaveappliedtheircommunicationskillstootherdiseasestoagreaterextentcomparedtothosewhosetrainingfocusedonavianinfluenza(Seegraphabove).

Whencomparingoverallcompliancewithdifferentoutcomes,thetrainingprogramreceivedasomewhatlowerscorefromparticipantsattheprovinceanddistrictlevels,andmayindicatethatadifferentapproachisneededforthesegroups.Theyhaverelativelygoodaccesstoinformationaboutinfectiousdiseases,butregularcommunicationislackingandoverallreachisrelativelylow.ApossibleexplanationforthisisthatgovernmenthealthpromotionstaffandmembersoftheIEC(information,educationandcommunication)teamsdonotalwayshavetheabilitytoconductsimilartrainingsorcampaignsbecauseprovincialordistrictofficesdonothavethefundsforsuchactivities.Notsurprisingly,accesstoinformation,targetreach,andfrequencyofcommunicationdeclinesevenmoreatthevillagegovernmentlevel,highlightingmoreroomforimprovement.Becauseofthis,itmightbeworthwhileforfuturetrainingstoemphasizemessagedissemination,targetaudienceselection,andeffectivemediastrategiesmore,especiallyin(most)situationswherethereislimitedfunding.

TrainingPerformanceDrivers

Thecapacity-buildingattributesmeasuredincluded:trainingpreparation;competenceoftrainers;trainingmaterials;trainingcontent;trainingcontentspecifictocommunication;andabilitytoimplementactivitiesafterthetraining.Whilethetrainersandtrainingmaterialsusedweregivenhighratingsonaverage,otheraspects–suchas“abilitytoimplement”garneredbelow-averageratings,indicatingthattrainingcontentshouldshiftmoretohelpingparticipantsfigureouthowtoimplementactivities.Partofthisresultalsomighthavebeenrelatedtothefactthatsomeofthetrainingswererelatedtoavianinfluenza,andtherewerenoAIoutbreaksfollowingthetrainingsthatwouldnecessitatetakingaction.Thecontentrelatedtocommunicationskillsingeneralwasratedhigh.

BehaviorChangeCommunicationwithLaoPoultryFarmers

Separately,resultsfromaKAPsurveyfoundthatanongoingBCCcampaignwithpoultryfarmersinLaoPDRregisteredapositiveimpact,withasignificantincreaseinreportedpracticesandknowledgerelatedtoprotectingpoultry(morethandoublingto59%from24%in2009,andalmostfourtimestheincidencefoundinthebaselinestudyconductedin2006).(ToevaluatetheavianflucommunicationcampaignundertheAI-BCCproject,

APPLyING TRAINING SkILLS TO OTHER DISEASE STATES


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abaselineKnowledgeAttitudeandPractices(KAP)studywasconductedin2006priortoprojectimplementation.Furtherstudieswereconductedin2007and2009,withthelatestsurveybeingcompletedin2011.The2011studyexpandedthecoveragetoincludePhongsalyandAttapueprovincesinadditiontothepreviouslycoveredprovincesofVientiane,LuangPrabang,Savannakhet,andChampassak,withatotalsamplesizeof1,440backyardpoultryfarmerhouseholds.)

AccomplishmentsinDenguePreventionandControlSince1985denguefeverhasbeenasignificantpublicthreatinLaoPDR.Outbreaksofthediseaseoftencomein2-3yearintervalsandaremostcommoninhighlypopulatedcitieswherehygienelevelscanbelowandwatercontainersareleftuncoveredorcarelesslydiscarded,therebyallowingmosquitoestoeasilybreed.Climatechangehasalsocontributedtolongerrainyperiods,whichcanleadtogreatermosquitodensity.

Inresponse,NEIDCOsupportedthecoordinationofdenguefeverpreventionandcontroleffortssothatalllevelsofactors–fromthenationalleveltothevillagelevel–wouldhaveaccesstothesameinformationandrecommendedinterventions.

Tocontributetothenationaleffort,MID-BCCconductedinitialresearchthatconfirmedalackofunderstandingabouthowtopreventandcontroldengueoutbreaksacrossaudiences.Amongotheractivities,MID-BCCdesigneddenguefeverpreventionmessagesandmaterialssuchaspostersandbookletsforhealthworkers,andtrainedhealthworkers,communityvolunteers,andyouthleadersonhowtodeliverthem.Theprojectalsoconductedanorientationformediasotheycouldbetterunderstandandreportondengue–andbecomeinvolvedincommunitymobilizationeffortstopreventthespreadofdengue.Totargetthebusinesses,orientationworkshopswithhumanresourcesmanagersandcompanyofficerswereheldin30factoriesinVientiane.Afterdiscoveringthatmanydoctorswere

Counseling Card #5: Clean places around your home where mosquitoes like to hide, like in cool, dark places, where water can collect.

Dengue Counseling Card #2: There is no drug to treat dengue, it can only be prevented.


unclearonhowtodiagnoseandtreatdengue,MID-BCCalsoprovidedclinicalcasemanagementtrainingondenguefeverformedicalstaffinhospitalslocatedinVientianeCapital,Savannakhet,Champassack,SaravanandAttapue.

PREPARING USEFUL MATERIALS TO EDUCATE ON DENGUEInSeptember2010,denguecasesinLaoPDRsoared,affectingeightprovincesandalarminghealthclinicsandoutpatientdepartmentsofthemainhospitalsinVientianeCapital.Thehighestnumberofcaseswasrecordedamongthestudentagedandyoungadultpopulations.TheVientianeProvincialHealthDepartmentneededcommunicationmaterialsforits“clean-up”communityoutreachandhealtheducationdrive,whichessentiallymobilizedvolunteers,suchasmembersoftheLaoWomen’sUnion,tourgecommunitiestoeliminatemosquitobreedingsitesandmotivatepeopletoseektreatmentwhencertainsymptomsappear.

MID-BCCreviewedanexistinggovernmentleafletondengue,andcommissionedalocaladvertisingagencyto

re-conceptualizeandpackagemanyofthesamedenguemessagesintoaseriesof10counselingcards.These10counselingcardswerefurtherusedasabasisforcreatingaposter;apocket-sized,eight-panelflyer;andabookletforhealthcareworkers.Projectstaffconductedapre-testtoensurethatthematerialsandthemessagescontainedthereinwereappropriateandeffectiveforhealthcareworkers,secondaryschoolteachers,andvillagers.Productswerefinalizedonlyafteritwascertainthatallofthematerialsresonatedwiththepeopletheyweretryingtoeducate.

EDUCATING THE MEDIA ON DENGUEMID-BCChelpedtheVientianeCapitalHealthDepartmentkickoffaninformationdrivetopreventdenguebeforethestartoftherainyreason.Onecomponentoftheinformationcampaignwasamediaorientationworkshopthatwasdesignedtoprovideover30mediapractitionerswithcorrectinformationabouttheAedesmosquito–theculpritbehinddengue--transmissionofthevirus,symptomsofinfection,andhowtopreventmosquitobites.

Counseling Card #6: Put larvae-eating fish “pahanukleung”in water containers.

Counseling Card #9: The symptoms of dengue can include high fever, severe headache, pain behind the eyes, joint pain, rash and mild bleed.


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InadditiontotheTV,radioandprintmediamembers,officialsfromtheWHOandtheLaoPDRMinistryofInformationandCultureattendedthesession.

IncollaborationwiththeVientianeHealthDepartment,MID-BCCheldaone-daytrainingtoequiphealthcareworkerswithcorrectinformation,messagesandmaterialsondengueprevention.ThetrainingwasattendedbyLaoWomen’sUnionrepresentatives,teachersanddistrictsupervisorsinsecondaryschools,andLaoYouthrepresentativesinninedistrictsoftheprovince.Theseparticipantslearnedhowtocommunicatetheriskofdengueeffectively,andreceivedachecklistofmosquitobreedingsitestobesurveyed,monitored,anddestroyed.Participantswerealsogiventheopportunity,bysector,tocharttheirdenguecampaignplansforthefollowingtwomonths.

HELPING MEDICAL PROFESSIONALS WITH CLINICAL CASE MANAGEMENT OF DENGUEToensurethatcasesofdenguehemorrhagicfeveranddenguefeverwerebeingdiagnosedandtreatedproperly,MID-BCCtrainedcliniciansonclinicalcasemanagementofdenguefeveranddengueshocksyndromeatkeyhospitalsinVientianeCapital.Thetrainingalso

includedasessiononhowtobestemployinterpersonalcommunicationintheclinicalmanagementofdengue.

ThetraininginVientianewasintendedtobuildandimprovethecapacityofhealthpersonnelinthecasemanagementofdenguefever,denguehemorrhagicfever,anddengueshocksyndrome(DSS)inmainhospitalsinVientiane;tocomeupwithatrainingagendafordenguecasemanagementsuitedtoprovincialanddistricthealthpersonnel;andtodevelopamongtheparticipantsacoregroupwhocouldserveastrainersintheprovincesinthefuture.

Oftheparticipants,15werehospitalclinicians,andtherestoftheattendeeswerekeystaffofNEIDCO,theCenterofinformationandEducationforHealth(CIEH),andtheMinistryofHealth(MOH).Thegroupadvisedthat,toensuresustainableprovisionoftrainingstoclinicians,medicalschoolsinLaoPDRshouldbeengaged,andthateachofthesemedicalinstitutionsandtheirprofessorscoulddevelopandupdatethetrainingcurriculumandaccompanyingmaterialstosuittheirpopulations.Thegroupalsorecommendedthatthegovernmentshouldnurturesomeclinicianstobecome“denguechampions”andpromotedenguecasemanagementactivitiesamongtheircolleagues.Finally,the

Media Orientation on Dengue.

Participants plan for their district and sector’s dengue communication campaigns.


groupsuggestedthatNEIDCOdevelopahospital-basedmodelforpreventionandcontrolofdengueandprovidetrainingusingthemodeltootherclinicians.

Advocating for More Cooperation from Communities in Preventing and Controlling DengueTohelphighlighttheimportanceofdenguepreventionandcontrol,MID-BCChelpedNEIDCOrepresentativescoordinateanadvocacymeetingfordengueinSavannakhetinMay2011.Themeetingwaspartofthegovernment’seffortstomobilizetheprovinceandseeksupportfromlocalauthoritiestopreventandcontrolpossibleoutbreaksofdengue.The97participantsincludedtheprovincialpartycommitteemembers,provincialhealthdepartmentofficials,districtcommitteeandcontrolofficers,religiousorganizations,andrepresentativesfromVietnameseandChineseassociations.

Asaresultofthemeeting,districtcommitteesandcontrolofficersvowedtoorganize,prepare,plan,andcontroldengueintheirdistricts.Thisincludedhavingdistrictcommitteesandcontrolofficersorganizecleaninggroupstodestroymosquitolarvae-breedingsites,andhavingprovincialanddistrictinformationofficerscontinuetodisseminateinformationtopreventdengueoutbreaksin

theircommunities.Moresignificantly,datafromtheLaoNationalCenterofLaboratoryandEpidemiologyshowedasharpdeclineindenguecasesin2011comparedto2010.

AccomplishmentsinEmergingInfectiousDiseasePreparednessUsingavianinfluenzaasafoundationfromwhichtowork,MID-BCCalsoaimedtostrengthenthecommunicationcapacityoftheThailand,CambodiaandLaoPDRministriesofhealthandagriculturesothattheycouldassumeagreaterroleinplanningandrespondingtoinfectiousdiseasesandemergingpandemicthreats.ThisincluderiskcommunicationtrainingsforgovernmententitiesandotherstakeholdersinThailandandLaoPDR,andadvocacysessionstogalvanizesupportforkeepingtabsonemergingdiseasethreats.

MID-BCCco-sponsoredwithGMS-RIDaTechnicalTrainingonJointCross-BorderCoordinatedResponsetoanOutbreakofaZoonoticDiseaseinthesummerof2010inPhuket,Thailand.Usingacasestudyonananthraxoutbreak,USAIDRDMA,FAO,andMID-BCCtrained68officialsfromcentral-andprovincial-levelpublichealthofficesandveterinaryofficesfromChina,Cambodia,LaoPDR,Thailand,andVietnam.Participantsweretrainedontopicssuchascommunicatingrisksduringan


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WhileitwasexpectedthatmanyBurmesemigrantscouldnotreadandwrite,thepretestfindingsrevealedthatthemajorityofmalariavolunteerswerealsoilliterate.Thismadetheneedforlow-literacymaterialsevenmoreimportant.

Itwasfoundthatinallcases,womenworkedalongsidethemeninalloccupations–rubbertapping,constructionandfishing–andneededtobeconsiderednotonlyasakeytargetaudience,butalsoasusefulmalariavolunteers.Theresearchfoundthat,ingeneral,womenweremoreengagedindiscussingmalariathanthemenwere,andweredeemedmorelikelytotakepreventionandtreatmentsteps--andtosupporttheirpeersandfamiliesindoingthesame.

Themalariaunitworkerswerefoundtobeavitallinkbetweenthemigrantsandtesting,treatmentandpreventioninformation.Assuch,itwasimportantthatthematerialsidentifytheseworkersandstrengthentheirrolewithinthemigrantworkercommunity.

outbreak,communicationskillsthatareessentialduringinvestigations,andhowtoofferrealisticrecommendationstocommunitymembers.

MID-BCCactivitieswentalongwaytowardsintegratinginformationacrossdiseasesandacrosssectorsaswell.AnexampleofthiswasintroducinggovernmentguidelinesoninfectiousdiseasestotheeducationsectorinLuangPrabang.

AccomplishmentsinMalariaPreventionandControlTheworkinmalariaillustratesgamutofcommunicationcampaignplanningandimplementation:formativeresearch,stakeholderinputsandpartnershipbuilding,pre-testing,productionofmaterialsandactivities,andtraining.InThailand,perhapsmoresignificantwasthatMID-BCCactivitieswereaimedatapopulationforwhichmalariahaspersistedasaproblemmaladydespitealloftheworkThailandhasdonetoeradicatethedisease:Burmesemigrants.

Atthebeginning,USAID,MID-BCC,andotherimplementingpartnersruminatedoverseveralformativeresearchstudiesonmalariaatthecommunitylevelinThailand.TheseincludedtheKAPstudyinPhuket,theParticipatoryActionResearchinMukdahanandChiangRai,andtheRapidEthnographicAppraisalinTratandChiangRai.TheprojectconvenedaMalariaResearchDisseminationandBehaviorChangeCommunication(BCC)PlanningWorkshopinFebruary2011thatbroughttogetherover55keyplayersfromvarioussectorswhowereinvolvedintheimplementationofmalariaprogramsmostlyintheborderareasofThailandandBurma.SomeprojectsalsoworkedintheborderareasofThailandandCambodia.

TheoverallobjectiveoftheworkshopwastoprovideparticipantswithanopportunitytoshareresultsandchallengesrelatedtomalariaBCCandtoidentifythestrategies,messages,andmaterialsneededtomoveforward.Thethree-dayworkshopprovidedparticipantswithanupdateonrecentmalariaresearchrelatedtoBCC,andanopportunitytosharetheirexperiences


Above: pretesting of malaria materials with Mon women (left) and Burmese migrant health volunteers (right) in Phuket.

andperspectivesonmalariabehaviorchangeandcommunicationinThailandandtheimmediateborderareas.Workinginsmallteams,themeetingallowedparticipantstodevelopbehaviorchangeandcommunicationobjectives;draftpreliminarymessages;andidentifyandprioritizecommunicationchannelsandselectedactivitiesforkeyborderprovincesusingavarietyofparticipatoryexercises,activities,andgroupwork.

Attheendoftheevent,Dr.WichaiSatimaiexpressedhisappreciationforthesuccessoftheworkshopinprovidinganopportunityforparticipantstoshareexperiencesandlearnfromeachother.AccordingtoDr.Wichai,“Integrationiskey;wecannotseparateonediseasefromanother.BCCcanbeappliedtootherhealthproblems,notjustonedisease.”

FHI360thenheldasecondmalariacommunicationmaterialsdevelopmentworkshopinPhuket,ThailandinMarch2011incollaborationwithKenanInstituteAsia(KIAsia)anddevelopedanactionplanforPhuketProvince.Theworkshopbroughttogether21representativesfrompublichealthofficesandhospitalsfromprovincial,districtandsub-districtlevels,whoareresponsiblefordeveloping,producing,orusingmalariacommunicationmaterialsintheirwork.Attheendoftheworkshop,participantssuggestedalistofmaterialsthattheyagreedwouldbeusefulfortheirwork.

Followingtheseplanningmeetings,itwasdeterminedthatfinalmaterialswouldinclude:

• Flipchartsandbookletstobeusedasjobaidsbyhealthcareworkersandmalariavolunteers

• Posterstoserveasremindermessagestobeplacedatkeylocationsinmigrantcamps,clinics,andconstructionsites

• Flyersfordistributiontokeyaudiences

Asrevealedbytheformativeresearch,oneofthekey

audienceswasmigrantworkers,particularlytheBurmese.Byandlarge,BurmesemigrantsprovidetherawlabortobuildThailand’smoderninfrastructure,housing,commercialandrecreationaldevelopments–includingmodernluxuriousapartments,offices,andgolfcourses.Despitetheircontributions,theBurmesearemarginalized,areoftenexploited,andhavedifficultyaccessinghealthservices.Itwasclearthattheyneededassistanceinaccessingservices,andbecauseresearchfoundthattheywerelargelyilliterate,low-litmaterialswereessentialforthispurpose(Seeboxonnextpageforadditionalresearchhighlights).Moreover,becauseBurmesemigrantshavebeeninThailandthelongestcomparedtoothermigrantgroups,theyarerespectedandtheiradviceisfrequentlysoughtbynewcomers.Asaresult,theproject’seffortsfocusedevenmorestronglyonthedevelopmentoflow-litmaterialsthatcouldbeeasilyunderstoodnotonlybytheBurmeseworkers,butalsoreadilyutilizedbyotherilliterateormarginallyliteratemigrantvolunteers.

PRE-TESTING OF LOW LIT MATERIALSAfterinitialprototypesofmaterialsweredeveloped,MID-BCCcollaboratedwiththePhuketProvincialHealthOfficetoconductpre-testingofthelow-literacymalariacommunicationmaterialsamongkeytargetaudiencesinPhukettoseeiftheywereusefulandunderstoodbytheMon,Karen,andBurmeseworkers.Specifically,thetestwasintendedtodetermineaudiencecomprehensionofandreactiontothematerialsintermsofculturalsensitivity,socialacceptance,andunderstanding.Thetargetaudiences


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Above: Original image of pandemic influenza flip chart (left), and adapted image (right).

interviewedincluded:Thaihealthcareworkers,migranthealthvolunteers,maleandfemalerubbertappers,maleandfemaleconstructionworkers,employers/supervisors,andmigrantfishingworkers.Becausethematerialswereintendedforlow-literacyaudiences,theemphasisofthepretestwasoncomprehensionofvisuals,toensurethattheyconveyedasmuchinformationaspossible,withorwithouttext.Thetestingalsoaimedtoensurethatvisuals

MID-BCCalsoprovidedanorientationintheuseofthematerialstomalariaworkersinPhuket,andpreparedthematerialsforadoptionatothersitesalongtheThai-Burmaborder.

MID-BCCalsoworkedcloselywithIRC’sSHIELDprojecttoadaptexistingavianandpandemicinfluenzamaterialstotargetaudiencesintherefugeecampsalongtheThai-Burmaborder.Severalimageswerere-designedtoreflecttherefugeecampsetting,andtheartworkwaspreparedtobereadyforprinting.

wererelevanttothecontextandlifestylesofthetargetaudiences,andtogatherinformationabouttherelativeutilityofdifferentformatsofcommunicationmaterials,includingflipcharts,flyers,posters,andbooklets.Intotal,sixfocusgroupdiscussionswereconductedoverthreedays.Researchfindingswerethentakenbacktothegraphicdesignagencytorefineillustrations,layout,andtextanddevelopthefinalmaterials.


Thethreadof sustainabilitywaswoventhroughoutthefabricof the

projectrightfromtheinitialresearch.MID-BCCenlistedofficersfrom

differentgovernmentofficestohelpwithdatacollectiononthevarious

rapidassessments,PARs,andKAPs.Wetrainednetworksof healthcare

workersandcommunityvolunteerswhocannowspringtoactionatthe

firstconfirmationof anoutbreak,withtheLWUmembersbeingaprime

exampleof this.AfteranavianfluoutbreakhittheVientianecapitalarea,the

LWUdistrictrepresentatives–135inall–mobilizedquicklythedayafterthe

outbreakwasannounced,fanningoutover90villagesthroughoutVientiane

withavianfluinformation,coveringallof theoutbreakdistrictsandsome

surroundingdistrictsaswell.Indeed,LaoPDRprovidesanimpressive

Threadsof Sustainability


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exampleof howagovernmentanditspartnerscancometogethertofight

infectiousdisease.TheNationalEmergingInfectiousDiseaseCoordination

OfficeinLaoPDR(NEIDCO)hasbecomeaglobalmodelforintersectoral

cooperation,combininghumanhealth,veterinaryexpertiseandresponsewith

communication,andthemobilizationof otherrelevantsectorsincludingcivil

society(throughfourmassorganizations–LaoWomen’sUnion,National

Front,YouthUnion,andLaborUnion),education,justice,foreignaffairs,and

laboratorycapacity.NEIDCOprovidesanumbrellatofacilitatethecooperation

of theUNorganizationsandinternationalNGOstoworktogetherundera

unifiedstrategy.Foravianflu,WHO,UNICEF,FAO,UNSIC,OIE,IOM,

FHI360andCAREallcollaboratedundertheaegisof NEIDCO.


VigilanceforEmergingInfectiousDiseasesStrengtheningthecapacityandawarenessofgovernmentstaffwillnotonlymakefutureresearchandcommunicationeffortsgomuchmoresmoothly,buthasalsocreatedabasisfromwhichtoadvocateforcontinuedworkagainstemerginginfectiousdiseases,notjustintheGreaterMekongSubregion,butthroughouttheglobe.Afterall,intoday’sworldofjettravelandextensiveglobaltrade,influenza-likeillnessescanmoveatthespeedoflight.Withouttheabilitytorespondquicklytotheseinfections,thereislittlethatpreventsinfluenza-likeillnessesfrombecomingpandemics.

Indeed,continuedvigilanceisimportant.Theprevioustwopandemicsofinfluenza-likeillness–SARSin2003andH1N1in2009–costmorethan300,000livesworldwide.TheWorldBankestimatesthatthenexthighlypathogenicavianinfluencepandemicwillcostbetween$1and$2trillion,or0.7to4.8percentagepointsoftheglobalGDP,dependingonseverity.Needlesstosay,wecancurblossesfrompandemicsandless-widespreadoutbreaksbyidentifyingthemintheregionswheretheydevelopandtakingaggressivemeasurestopreventandcontainthem.

AsanintegralpartofseveraloftheworkinggroupswithinNEIDCO,includingtheCommunicationTaskForce,theResearchWorkingGroup,andtheMarketsWorkingGroup,theMID-BCCprojecthelpedLaoPDRtoincreaseitsAIresponsecapacity,developnationalindicatorsandtargets,andmeasureitsaccomplishments.LaoPDR,infact,islikelyoneofthefewcountriesthatcandemonstratebehaviorchangeresultsbasedonagreed-uponnationalindicators(measuredthroughrepresentativesurveysdevelopedbyFHI360andadoptedbyNEIDCO,andlaterfundedandimplementedthroughWorldBankfundswithtechnicalassistancefromMID-BCC).

PARALLELS WITH THE GLOBAL HEALTH INITIATIvE ThisworkhasdovetailedwellwiththegoalsoftheGlobalHealthInitiative(GHI),whichadvocatesforbuildingsustainabilitythroughhealthsystemsstrengthening,aswellasstrengtheningandleveragingkeymultilateralorganizations,globalhealthpartnerships,andprivatesectorengagement.TheinstitutionalizationofourskillsintheLaoWomen’sUnionspecificallymesheswiththeGHIpillarofimplementingfemale-centeredapproachestobothtoimprovehealthoutcomesforwomenandtorecognizethatwomenarecentraltothehealthoffamiliesandcommunities.TheLWUexperienceusingSMStoshareinformationonoutbreaksandcollectdatahaspromotedtheprinciplesofresearchandinnovationtoidentifywhatworks–yetanotherGHIcomponent.

The MID-BCC project helped Lao PDR to increase its AI response capacity, develop national indicators and targets, and measure its accomplishments. Lao PDR, in fact, is likely one of the few countries that can demonstrate behavior change results based on agreed-upon national indicators.


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DespitealloftheaccomplishmentsunderMID-BCC,itwasdifficulttoconstructanintegratedproject.Theopportunitiesandinterestweretheretocombinecommunicationeffortsandworkon"influenza-likeillnesses",butduetonon-integratedfundingstreamsforavianflu,malaria,anddengue,theseactivitiescouldnotbemerged.Aswasrepeatedlyobservedintheresearch,“afeverisafever”inthevillage.Mostpeopledonotdistinguishbetweendifferentdiseasesthatmakethemfeelill.Theyfocusontheseverityofsymptoms,anddonotusuallybothergoingtohealthcareprovidersunlessafeverlastsforseveraldays.Figuringoutwhentoworry,whentotakeaction,andwhentonotifyauthoritiesrequiresastrongerinfrastructureandgreateraccesstointegratedinformationthatiscurrentlynotavailable.

Thehope,however,isthatcountriesinSoutheastAsiacancontinuetostrengthenthecapacityoftheircommunityresponders,volunteers,communeanddistrictleaderstoplanandrespondeffectivelyforallpossibleoutbreaksofinfectiousdiseases.Thattheycanorientkeycommunitystakeholdersandvillage-levelinfluentialstotheimportanceofmaintainingawarenessandeducationonemergingdiseasethreats,andincreasetheinvolvementofcommunitiesandvillages–andthepeoplewithinthem–tolendahandinpreventingoutbreaksthroughbiosecuritymeasures,orattheveryleastknowinghowtowatchoutforthem--regardlessofthevirus.


OurOwnWords:NotesfromtheBlogosphere• RevisitingthemarketsinLaoPDR:AvianInfluenzaRiskReductionCampaignsbeforethePiMai.

• LearningAdvocacy:BuildingfromWhatisKnowntoUnknown.

• Dhammayietra22:AvianInfluenzapreventionduringtheannualmonks’peacewalkinCambodia.

• AvianInfluenzaPreventioninCambodia:CommunityForums.

• MID-BCCinCambodia:TrainingtheFrontlinesonRiskCommunication.

• MID-BCCinCambodia:TrainingtheFrontlinesonRiskCommunication,PartII.

• HighRiskCommunicationTrainingInBattambang,Cambodia.

• OneCommunity,OneSchool,OneHealth

• StrengtheningtheRiskCommunicationCapacityof Cross-BorderProvinces:SavannakhetandChampasack.


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Ifindthisprojectactivityveryinteresting.Allmylife,themarkethasbeenasignificantpartofmyroleasamother–andnowasacountrymanagerofaninfectiousdiseasesproject.

(Editor's note: minor edits have been made to the author's original report.)

Ialwaysgotothemarkettobuyfreshfish,meat,vegetables,fruitsandothercommoditiestosuitmyrequirementsinpreparingfoodformyfamily,butIneverrealizedthatthemarketmeansmorethanaplacewhereexchangeofcommoditiesandservicestakesplace.

Mypresentengagement(representingtheMID-BCC)withthemembersoftheMarketWorkingGroup,whichisledbytheDepartmentofHygieneandPreventionundertheMinistryofHealth,hasprovidedmetheopportunitytocloselylookatthesituationinthemarketandobservethebehavioroftradersandvendorsthatbearrelevancetohealth.Apartfrommakingyourfoodsuppliesavailable,theyalsokeepthesefoodsuppliessafeandclean,particularlyavoidingcontractionofvirusesandbacteria,whichcauseinfectiousdiseases.

Marketsvaryinform,scale(volumeandgeographicreach),location,typesofpeople,andtypesofgoodsandservicestraded.InLaoPDR,retailmarketssuchasthelocalfarmersmarketsaresituatedintownsquares.MarketsoperateunderthesupervisionoftheDomesticTradeDepartmentoftheMinistryofIndustryandCommerce.By2007,616marketswereofficiallyregistered(52large,130mediumand328small).Localfarmersmarketsincludevegetables,fruits,andbackyardpoultry.

Amonglocalpeople,themarketisthecenterofeconomicactivities.Farmer-producersbringtheirproductsandsellthesetoeithertraders/sellersordirectlytoconsumers.Fromthepublichealthperspective,themarketisahubfortherapidspreadofinfectiousdiseaseswiththecontinuoustradingofliveandslaughteredanimalsandthemovementoftoomanypeople.Themarketisonekeysegmentofexposuretoavianinfluenza.

In2007,withsupportfrominternationaldonorsandpartners,thegovernmentinitiatedthenationalMarketWorkingGroupundertheleadershipoftheDepartmentofHygieneandPreventiontomonitorandimplementactivitiestoavoidtheriskoftransmissionofavianinfluenzatoanimalsandpeopleinmarketplaces.Beforetheendof2009,marketworkinggroupswerealsocreatedinthekeycitiesoftheBokeo,LuangNamtha,LuangPrabang,ChampassackandSavannakhetprovinces.

TheMID-BCCProjectprovidedsupporttothenationalMarketWorkingGroupbyconductingacleancampaigntoremindmarketadministrators,meatandpoultryvendors,traders,andslaughtererstorepeatthemessagesofhandwashingandcleaningtoavoidvirustransmissionfromanimalstoanimalsandfromanimalstohumans.Specifically,thetechnicalassistancewasaimedat:(1)seekingthecooperationofandre-orientingthemembersoftheMarketWorkingGroup’sleadershiptorepeatthemessagesofhandwashing,separation,cleaningandotherbirdflu-relatedmessages;and(2)mobilizingmarketadministratorsandleaderstoconducta“clean”campaigninthemarket.

Revisiting the markets in Lao PDR: Avian Influenza Risk Reduction Campaigns before the Pi MaiByCecileLantican|April4,2012


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In Lao PDR, the street could even be an extension of the market. The morning market of kouadin hosts farmers to selling their local produce from 5:00 a.m. to 7:00 a.m. only. khounkham Xaymounvong and I joined the market working group team in its "clean campaign" at Thongkhankham market in vientiane.

Right: A fruit section of Thongkhankham market in vientiane Capital.

Left: A village market in Houaxay district, Bokeo province, where locally produced vegetables are sold.

Chickens and ducks are an important part of the Laotian meal during Pi Mai.

At the kouadin market, the Market Working Group team lead by Dr. Phonexavay Chantaseng held the orientation among sectoral market leaders in the small office of the market administrator. The limitation of space was never seen as a problem for other interested market traders and vendors; they participated outside the room.

The town market in vang vieng, vientiane province, where you can find exotic wildlife meat.


ThePiMai(LaoNewYear)willbecelebratedonthesecondweekofApril.Itisexpectedthatduringtheseason,therewillbevoluminoustradingandslaughteringofpoultryinthemarket.MID-BCChascollaboratedwiththeMinistryofHealth,DepartmentofHygieneandPreventiontomobilizetheMarketWorkingGroup,whichwasearlierorganizedthroughWHOandCAREunderUSAIDandUS-CDCfunding,respectively,in2009.UndertheguidanceofWHO,thegovernmentpromotedinthepastkeymessagestomaintainacleanmarketenvironmenttoreducetheriskofavianinfluenzavirus.

ThecleancampaignkickedoffonMarch19to21inthreemainmarketsinVientianeCapital–ThongkhankhammarketinSisattanakdistrictandNongchanandKouadinmarketsinChantaboulydistrict.Thethreemarketsareoperatedbyprivatemarketownersorindividualsbutaresanctionedundergovernmentmonitoring.TheThongkhankhamandNongchanmarketscatertoabout1,000peopleaday,whereastheKouadinmarketprovidesservicestoaround2,000peopleaday.

Oneobjectiveofthecampaignistoremindpeopleofpreviousavianinfluenzapreventionmessages.Postersarestillhangingonroofbeamsandposts,butIwasnotabletoaskifpeoplestillreadthemessageswrittenonthem.

IwasamazedbythecreativityandproactivemoveofthemarketworkinggroupteamtointegrateintheorientationthehandwashingpracticetoavoidotherdiseaseslikediarrheaandH1N1.Diarrheaisthemostcommonhealthcomplaintamongpeoplelivingintheareasurroundingthemarkets.

ThiscleanmarketcampaignwillbeimplementedinothermainmarketsinBokeo,LuangPrabang,LuangNamtha,Savannakhet,andChampassack.

Revisiting the markets in Lao PDR Avian Influenza Risk Reduction Campaigns before the Pi Mai (Continued)

The team did an ocular observation of the markets. Poultry meat vendors in particular clean their spaces after selling their products. Stainless steel tables in the meat section in kouadin market, which were provided through USAID and WHO assistance in 2009, are washed.


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Throw rubbish into the bins to reduce the spread of disease.

Proper hand-washing techniques were reinforced during and after the orientation. Ms. Siphay vongsouangtham, technical staff from CIEH, MOH facilitated the demonstration. The washing facility was one of the market improvements provided by WHO with USAID support in 2009.

Posters: Wash your hands with soap every time you touch raw meat to reduce the spread of disease.

Cleaning in the market is done at the end of the day.

One of the vendors who attended the orientation and demonstrated cleaning of her stall after selling all her dressed chickens.

zoning stalls will reduce spread of disease.


CecileLantican,MID-BCCCountryCoordinatorLaoPDR,facilitatedanadvocacytrainingworkshopMay2and3,2012,for22governmentstaffmembersfromtheMinistryofAgricultureandForestry(MOAF)inVientiane,LaoPDR.

Advocacyisanuancedcommunicationstrategyandanimportantfirststepincreatingbehaviorchangeamongcommunitiesandorganizations.Advocacyiswell-developedandexpertlyexecutedinmanycountriesandcultures,especiallyintheWest.Therearesomecultureswhereitisnotconsideredappropriatetoadvocateforacauseoranissue…andsomegovernmentslooklesskindlyonnon-governmentaladvocacyactivities.

OnMay2and3inVientiane,IfacilitatedanadvocacytrainingworkshopforthegovernmentstafffromtheLaoPDRMinistryofAgricultureandForestry(MOAF).Ourparticipantswerenotfamiliarwiththeconceptofadvocacyandhadnoexperiencewithadvocatingforanissue.Thismadetheworkshopbothchallengingandrewarding.

Twenty-twomiddlemanagersandsupervisorfromvariousdepartmentsofMOAFparticipatedinUSAID’sMID-BCCtwo-dayadvocacytrainingheldMay2-3atSetthaPalace,VientianeCapital.

InplanningdiscussionswithDeputyDirectorGeneralofPlanningDr.SomphanChangphenxay,Inotedthatequippingthegovernmentstaffwiththeneededcommunicationandadvocacyskillswouldenablethemtoachievemoresupportandservicesintheirgovernmentfunctionsastheyrelatetotheirstakeholders,organizations,relevantpublicsandotherprofessionals.

Learning Advocacy: Building from What is Known to UnknownByCecileLantican|May8,2012

Theadvocacytrainingwasthesecondcommunicationcourse,aftertheriskcommunicationtraining,whichprovidedtheparticipantsthebasicconceptsandprinciplesofcommunicationandbehaviorchangecommunication.

Theadvocacytrainingwasaimedto:strengthenthecommunicationcapacityofselectstafffromrelevantdepartmentsofMOAF;anddevelopacoregroupofstafftrainedinallaspectsofcommunicationandthatcanprovidetechnicalsupporttotheMinistry’scommunicationneedsoverthelong-term.

MytrainingteamwascomprisedofKhounkhamXaymuonvongandSiamphoneMahindorathepfromourMID-BCCProjectoffice.Thechallengetouswasapplyingaparticipatoryprocesstolearningaboutadvocacywhenitwasn’tapracticetheywerefamiliarwith.Wecouldnotjusttellthemaboutadvocacy;weneededtoshowthemthroughgoodexamplesandthenapplythattotheirownprofessionalsituation.

Iwasmindfulofthepriorknowledgeandbackgroundoftheparticipants,howbestIcouldexecutethestepsproposedinthetrainingguide,andmoreimportantly,—howtheparticipantsandIcouldbestachievethelearningoutcomes.

IwasalsoconsciousoftheprocesstoensurethatIwouldnotmissanystepoftheguide;itwasmyfirsttimetousethisadvocacytrainingguide.Mytrainingapproachwastoengagetheparticipantsinacollectivelearningenvironment.I,thetrainer,andtheparticipants,wouldtakethejourneytolearntogether.Ibelievedthatourmotivationwoulddetermineanddirectwhatwedointhetraining


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Twenty-two middle managers and supervisor from various departments of MOAF participated in USAID’s MID-BCC two-day advocacy training held May 2-3 at Settha Palace, vientiane Capital.


roomtolearn.The22staffwereaskedtobeseatedinfiveroundtables,eachtableprovidedwithamicrophoneandonecomputerwithaccesstoWi-Fi.

Thetrainingvenuewasrearranged,makingitmoreconducivetolearning.Therewasenoughspacefortheparticipantsandtrainertomovearoundandinteract.Inaddition,theinternetconnectionwasefficient.Theparticipantsandtrainerusedrecommendedwebsourcesforthetraining.

Therewereseveralexamplesweusedinthetraining–H5N1virus,floods,andHPVvaccine–thatwereissuesthatourparticipantswouldrelateto…TheThaifloodsarestillamajortopicintheregion;outbreaksofH5N1virusarestillprevalentintheregion;andvaccinesareaconstantpublichealthprioritywhichiswhywefocusedontheseexamples.Myassistant,Siamphonedistributedthefirsthandout.Handout#1providedvariousimagesthatexemplifiedtheconceptsandterminologiesofchange,policy,attention,andsupport.Myfirstquestiontobreaktheirsilence:Whatdoyouseeontheseimages?What’sgoingon?

Asexpected,theparticipantswereabletorespondinreferencetothethreeimages–thesandbags,HPVvaccine,andprotectiveequipment.Otherimages,whichincludedtherevolutionarywavesofdemonstrationoccurringinArabcountries,theLivestrongwristband,andOccupyWallStreetmovement,werelessfamiliartotheparticipants.

ToaugmenttheexamplesandmakeitmorerelevanttotheLaosetting,Ireplacedtheotherexampleswith

threeimagestheywouldbemorefamiliarwith.TheseweretheimagesofLaomenmarchinginthestreetwithplacardsof“notosmoking,”themonkssupportingthecause,andtwoprominentpeopleinVientianeCapitalspeakingoutontheissue.

IdistributedbackissuesoftwoLaonewspapers–TheVientianeTimes(inEnglish)andPathetLao(inLao).Iaskedparticipantstoreadnewsarticlesandstoriesthatwereofinteresttothem.Thereafter,Iaskedthemtoclipimagesandstoriestheylikedtopresentthemeaningofsupport,attention,change,policy,andthelaw.

Participants’priorknowledgecouldfacilitatelearning.Isharedwiththemotherphotos(inmyPowerPoint).Itookthephotos(below)infrontofourofficethedaybeforethetraining.Everyoneexpressedhis/herunderstandingofthemessage,giventheirawarenessofthecurrentadvocacybythecitygovernmentthatpeopleontheirmotorbikes–youngandold,menorwomen–shouldwearhelmets,otherwiseacorrespondingpenaltywillbeimposedforviolatingthistransportrule.

Withthenewspaperclippings,theparticipantsorganizedtheirthoughtsandbegantoidentifyexamplesofadvocacybeingappliedtoapubliccause.Forexample,oneparticipantexplainedthemediaplanbythegovernmenttoadvocateforimmunization.

Inadvocacy,muchdependsonenlistingthepeoplewhohavetheinfluencetomakeadifference(Handouts#4and5).Thenewspaperclippingsshowedthemexamplesofwhowerethe“influentials”inthegovernmentserviceandintheircommunities.

Learning Advocacy Building from What is Known to Unknown (Continued)


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Tohelpthemunderstandthequalitiesofthe“influentials”beingdiscussed,IshowedthemavideoofthreeimportantfiguresinLaos.IrequestedthevideoclipsfromLaoStarTelevision.ThevideocontainedfootageoftheLaoPresident,theCommitteePartyAdministrator,andonegovernor.

Thevideoenabledtheparticipantstodescribethecharacteristicsandqualificationsofinfluentialswhocoulddosomethingaboutissuestheycaredabout.

TheNotOnOouWatchwebsitewasusedmaximallytodemonstratehowtodoaninfluentialanalysisandobtainpracticalexamplesofmessaging.Someparticipantsusedtheirmobilephonestoaccesstheinternet.

Withtheinternetconnectionintheroom,theparticipantsandIexploredtogetheranddiscussedmoreexamplesoftraditionalandnon-traditionaloutletsandchannels.Weexploredtheinternettogether:–wevisitedvariousadvocacywebsitesandstudiedsomeexamples.

Thedownsideofthisapproach,however,wasthefactthatthewebsiteswevisitedwereinEnglish.Englishisathirdorfourthlanguageformostofourparticipants,anditdidtakemoretimetoreadandcomprehendthecontent.Nevertheless,Iwasconfidentthatthroughtheinternet,learningwasmoreinteractive,evolving,andanexperientialprocess.

Thehotseatexerciseputtheparticipantstothetest.Workinginpairs,Iaskedthemtoworkonanissuetheythinkisimportantintheirprovinceorcommunity.Onehadtoplaytheroleofacommunityleaderandonewasthedecisionmaker.

Awomanwhoactedasafarmerfederationleaderpresentedtothetownmayorthefarmers’problemonirrigation.Thefarmers’riceproductionwaslowbecause

Learning Advocacy Building from What is Known to Unknown (Continued)

oflackofwatercausedbytheclosingofthenationalirrigationsystembytheprovincialgovernment.

Adialoguebetweenthepresidentofthestudentorganizationandauniversitypresidentwasplayedout.

Thestudentleaderadvocatedforthestudents’concernofthegrowingnumberofstudentswhosmokeandlitteronthecampus,whichalsoappliedtothestudent’s“cleanlinessandsavetheenvironment”campaign.

OneMOAFstaffmember,whoservedastheManagerofInformationandwasin-chargeofthelibraryandknowledgemanagementdepartmentofMOAF,demonstratedhowtopresenttotheExecutiveDirectorofPlanningandInvestmenttheproblemofoldcommunicationequipmentsuchascomputers,internetconnection,accesstonewpublicationsandjournals,anddeterioratingservicesofherdepartment.

Attheclosingofthetrainingonthesecondday,onestaffmemberfromtheFacultyofAgricultureatNabongAgriculturalUniversityvolunteeredtosharehertestimonyaboutthetraining.

Dr.Somphan,inhisclosingremarks,stressed,“Advocacyskillscanbeappliedinanyissuesthatyouareconfrontedwithinyourrespectivedepartments.Ienjoinyoutosharethisknowledgeandskillwithyourcolleaguesandstartinformingyourstakeholdersofwhatyouaredoingsothatyoucangettheirsupport.”

Thesharedlearningwiththeparticipantswassuchafulfillingexperience.Itcouldbe“difficult”intheprocessyeteffectivebecausethemotivationtolearnwasinternallygeneratedamongtheparticipantsthemselves.


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I joined this training with

no idea about advocacy. But

I appreciated the learning

process I experienced with

my group. I am an educator

myself. I find this kind of training very useful. I

believe that this training entails greater costs to

FHI 360, but if we pass on the learning to others

and the learning will be applied, then the costs

would be lesser.



Everyyear,CambodianmonkspartakeintheDhammayietra,apeacewalk.Thisyear,MID-BCCsupportedthemonksbyprovidingtrainingandmaterialsforthemonkstospreadavianinfluenzapreventionmessagestotheschoolsandcommunitiestheyvisited.MID-BCCconsultantTongngyKaingaccompaniedthemonksfortheirtrainingandthefirstpartoftheirwalk,andsharedhisexperiencewithus.

Dhammayietra 22: Avian Influenza prevention during the annual monks’ peace walk in CambodiaByTongngyKaing|March20,2012

(Editor’s note: minor copy edits have been made to the author’s original report)

March10,2012Ilefthomeveryearlyat6a.m.togotothebus/taxistation.Sincetaxiisfaster,ItookataxifromPhnomPenhat7a.m.toSiemRiepandthentookanothertaxifromSiemRieptoSamrongOddarMeanchey.Iarrivedatabout5p.m.andstayedinasmallhotelcalledHengMeanCheyHotel.

Udom Syvorn is the coordinator of the pre-walk training, where about 40 monks participated.

As a part of the pre-walk training, monks were trained on how to properly wash their hands with soap in order to prevent H5N1 and other diseases.

Each team had to demonstrate hand washing while the others observed

Each monk read the hand-washing poster carefully before they demonstrated the practice.


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March11,2012Pre-departuretrainingtookplacefromMarch10to11,butIcouldjoinonlyonthe11th.Itstartedat7:30andfinishedatabout11:30.ThecontentsofthetrainingareBuddhism,prayer,disciplinesofthewalk,howtoteachstudents,andgeneralguidelines.Butwhatisinterestingisthattherewasa30-minutetrainingonhowtoteachhandwashingtostudentsandchildrenatabout10:00.Therewasarevisionofhowtowashhandsproperlyforallthemonks.SinceIhadsomeA4postersfromFHI360here,Igaveonetoeachofthe40monks.Eachofthenineteamsofthemonkswasaskedtoshowhowtoproperlywashtheirhandswithoursoap.Iguessitwasthemostinterestingpartofthetrainingsinceeveryonecouldgetupanddoactivities.

Trainingresumedatabout1:30.Mostlyguidelinesanddo’sanddon’tswerediscussed.Oldermonkssharedtheir

experiencesofthepreviouswalks.Thentherestwasaboutlogisticsandpreparationofthematerialsforstudents’trainingthenextday.Workfinishedatabout5p.m.

ThefirstdayofDhammayietra22didnotbeginwithwalking.Onthefirstday,monksweredividedintoninegroupsandsenttoninedifferentcommunitiesinthreesankats.Eachgroupwillhavetoteachbetweentwoandfourschoolsonthefirstday.

Theschooltrainingsfinishedinthemorningbecausesomeschoolswithintheneighborhoodcombinedtheirstudents,sotherewereonlyoneortwotrainings.

Inthelateafternoontherewasanothermeetingforlogisticpreparationfortherealwalkthenextday.Themeetingwasfrom4p.m.to5p.m.

Hand-washing training was probably the most interesting part of the whole-day training, based on my personal observation.

Between 60 and 100 bars of soap were prepared for each of the 39 schools.

Each school would receive this set of materials, including soap bars.Monks helped Syvorn to

prepare all the materials for the next day’s training in 39 schools.

2,000 bars of soap are delivered to 39 schools, eight pagodas, and five sangkat/ communes.


Dhammayietra 22: Avian Influenza prevention during the annual monks’ peace walk in Cambodia (Continued)

The Monks’ meeting began early, at 4 a.m., but I joined them at almost 5 a.m.

Monks and materials including soaps were transported on the locally designed vehicles to schools at a distance of less than 10 kilometers.

By 6 a.m., everyone is ready for the adventure, without breakfast yet.

Training at the first primary school began at 7:40 a.m., and there were about 200 students.

Protecting their community against H5N1 by washing hands was one of the main topics in the student training. The rest were the main concepts of Buddhism, peace and violence, environment, health, and social issues.

The monks demonstrated hand washing while kids were observing carefully before a few of them would be invited to participate.

Time for kids to show their skills.


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There was not enough soap for everyone, so Syvorn decided to allow the teachers to give soaps to students who really needed to improve their personal hygiene with soap.

The second school was bigger, with about 300 students. When we arrived, around 100 members of the public were also waiting with students.

When it was time to demonstrate hand washing, everyone watched intently.

The public was also invited to practice hand washing.

Posters illustrating proper hand washing were also displayed at each school. Plenty of food and drinks

were offered to the monks after the training.

“To prevent bird flu, washing hands with soap is important, but ash is ok if there is no soap,” a monk said while a student demonstrated hand washing.


Dhammayietra 22: Avian Influenza prevention during the annual monks’ peace walk in Cambodia (Continued)

March13,2012Thewalkbeganat6inthemorningwithmonks,laypeople,foreigners,andguests.Theywentaroundthetownbeforeheadingtoanotherpagodaaboutsevenkilometersawayfromthetown.Wehadbothbreakfastandlunchatthepagodabeforeheadingtoanotherpagodaatnearlya10-kilometerdistance.Thetotalwalkonthefirstdaywasover10kilometersanditwasexhaustingwork.Ileftthemarchlateafternoonandwalkedaloneaboutanothertwokilometers,findingamotorvehicletoreturntoSamrong,OddarMeachey.▪

The march went around the city of Samrong, Oddar Meanchey.

Samrong, Oddar Meanchey

After the town, the march headed up the national road.

People were waiting in the street for the monks to bless them. They also offered food and drink to the monks. But money was not accepted during the peaceful walk.

“May the prayers help you avoid being sick and live in prosperity. But don’t forget to wash your hands regularly, go to the health center when not well, and never use drugs and violence,” blessed the monk while throwing water on the man.

The monks prayed before they could start their very late breakfast and early lunch. Buddhist monks do not eat anything from 12 p.m. to 12 a.m.


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Avian Influenza Prevention in Cambodia: Community ForumsByTongngyKaing|April17,2012

ItraveledtoKampot,SvayRieng,KandalandBattambangthelastweekofMarchandfirstweekofApril-justbeforeNewYears-tohelporganizeandfacilitatecommunityforumsonpreventionrelatedtobirdflu(H5N1virus).

Becausethesecommunitieshavemostrecentlyhadoutbreaksofthevirusorremainedasgatewaysofpoultrytransportationfromothercountries,therewasalotofpublicinterest.About500peoplejoinedtheforumineachofthefourborderprovinces,andlocalTVstationssuchasCTN,Bayon,andTVKalsocoveredtheforums.SinceCambodiawaspreparingtocelebrateitstraditionalNewYear(ChaulChnamThmey)April13to15,itwasagoodtimetoholdthesemeetingsbecauseduringthefestival,foodsincludingpoultryarebeingtransportedtomostpartsofthekingdom.

The four H5N1 high-risk border provinces where community forums were held.

Super Moan has been an icon to fight against avian influenza. Even children know Super Moan well.

The forum in Svay Rieng was held in a pagoda, just a few kilometers from the vietnamese border. Authorities said villagers sometimes brought sick or dead poultry from vietnam, which occasionally contaminates poultry in the village.

Thmor kol district is about 50 kilometers away from Battambang city center, but road access is very good.


Expertsfromtheveterinarydistrictofficeandanofficial,Dr.SokSaryfromtheMinistryofHealthinPhnomPenh,attendedeachforumasguestspeakers.ThevetdemonstratedhowH5N1contaminatespoultryandDr.Saryexplainedhowthevirusaffectshumans.

Tohumanizethetopic,oneofthetwoavianinfluenzasurvivorsinCambodia,Mr.KengSopheak,alsospokeattheforums.Heisoneofthe20humancasesreportedinthekingdom,andsharedhisexperienceonhowhegotthevirusandhowhecouldsurvivethekillerdisease.

“Myauntwasadistricthealthworker,andwhenIwassicksheunderstoodthesymptomsbecauseshejoinedabirdflutraining.ShethenquicklysentmetoCalmetHospital.ThenIknewnothinguntil20dayslater,”SopheaksaidintheforuminKandalwhilethecrowdlistenedtohiminsilence.

Birdflupostersandsoapbars,providedbyFHI360,weredistributedtotheforumparticipants.FHI360alsosponsoredfivevillagehealthworkersandthreeheathofficersfromthecommune,district,andprovincelevelstoparticipateineachforum.TheFoodandAgricultureOrganization(FAO)shoulderedallexpensesoftheforums.Thecommunityforumswerefurtheractivelysupportedbylocalauthoritiesandgovernmentofficials.

Unfortunately,duringmytripbackfromKandal,anewsuspectedH5N1caseinKampongChhnangwasreported.AnofficialpressreleasefromtheMinistryofHealthonApril2confirmedthatasix-year-oldgirlhaddiedofH5N1.▪

About 500 participants gathered for the community forum in kampot.

Avian Influenza Prevention in Cambodia: Community Forums (Continued)

About a third of the participants in Svay Rieng are students. This is their first time learning about bird flu, according to the school principal.

When asked who raises chickens and ducks, some participants raised their hands.


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There are more than 500 people in Battambang. The condition of the population here is better than in Svay Rieng, kandal or kampot.

At the end of the forum, there is a Q&A session where people can answer the questions to get prize.

“Playing with paper or plastic birds can’t affect H5N1,” Dr. Sok Sary of MoH said.

“Are you ready for Q&A?” Chanthol of FAO asked participants.

Dr. Son San of NavRI and Banteay Meas district governor also were guests at the forum.

A veterinarian from Thmor kol district presented how H5N1 spreads from one bird to another.

To cheer up the participants, Dr. Sary told a joke which made everyone laugh. Some villagers called him Dr. Comedian.


Avian Influenza Prevention in Cambodia: Community Forums (Continued)

village vets and health workers were introduced to the public. “If you see any suspected cases of AI, please report it to us,” the blue shirted vet said.

Dr. Sok Sary of MoH described how he saved Sopheak in 2008, and how H5N1 developed in Sopheak’s body.

Sopheak became a star among the audience. When he was sharing his experience, everyone listened to him carefully and quietly.

“I am lucky to be alive because my aunt who is a health worker learned about bird flu,” said Sopheak, one of the two Cambodian AI survivors.

While participants were watching AI educational spots before the forum started, village vets and students were actively preparing packages.


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A participant gets this package and some big posters.

Messages on the soap bars: Together against Bird Flu in Cambodia: keep chickens away from ducks, wash your hands after touching chickens or their remains, clean and burn poultry’s remains, separate sick chickens or ducks, and keep new chickens or ducks away from other animals for two weeks before releasing them with the old ones.

Posters like this were delivered to the people. “Report immediately,” states the poster.

Posters were very popular among the villagers. “I am going to stick it on my wall at home,” a villager said, when asked what he was going to do with the poster.

During the forum, participants listened carefully. “The more we know about AI, the more we know how dangerous it is. I do not usually care about AI, but after this forum, I will be more careful with my chickens,” a participant said to his friends.

keep your new poultry away from other animals for 14 days, the poster reads.

A village vet gives soap bars to participants.


CecileLantican,MID-BCCCountryCoordinator,LaoPDR,traveledtoPhnomPenh,CambodiatotraineightmembersofthenationalrapidresponseteamonriskcommunicationfromJune20-21,2012.TheparticipantsofthenationaltrainingwilltrainprovincialanddistrictteammemberstoenhanceCambodia’scapacitytorespondeffectivelytoaH5N1outbreak.


“AvianinfluenzaisstillathreattothehealthofCambodians,”saidHEMamBunHeng,MinisterofHealthinajointpressreleaseon28May2012betweentheMinistryofHealth(MOH)andtheWorldHealthOrganization(WHO).

Thisjointstatementdeclaredthecountry’s21sthumandeathfromtheH5N1virus.ThiscasewasthethirdpersonwhodiedthisyearinCambodia.

ThefightagainsttheH5N1virusinCambodiaiscontinuing.Thegovernment,throughtheTechnicalWorkingGrouponH5N1withrepresentativesfromtheCommunicableDiseasesControl(CDC)oftheMOH,NationalVeterinaryResearchInstitute(NaVRI)undertheMinistryofAgricultureForestryandFisheries(MAFF),andinternationalorganizationslikeUnitedNationsInternationalChildren’sFund(UNICEF),FoodandAgricultureOrganization(FAO),andWorldHealthOrganization(WHO),havecontinuallymobilizedtherapidresponseteamtoensurethateverynecessarymeasureistaken,includingsurveillance,provisionofadequateandtimelyepidemiological,laboratoryandfieldinformation,andconductingpublicawarenesscampaigns.

MID-BCC in Cambodia: Training the Frontlines on Risk Communication ByCecileLantican|June28,2012

ItravelledtoPhnomPenhonJune18toextendassistancetothecurrentworkoftheUSAID-fundedMID-BCCproject.Sincethefirstquarterofthisyear,MID-BCChasprovidedsupporttostrengthenthecommunicationandoutreachcampaignofthegovernmenttoreducetheriskofH5N1virus.

Myrolewastotrainthetrainersfromthenationalrapidresponseteamonriskcommunication.ThenationalH5N1rapidresponseteamiscomposedoftechnicalstafffromtheNAVRIandCommunicableDiseasesControl,andrepresentativesfrompartnerorganizationslikeFAOandWHO.TheteamisresponsiblefortakingthefirststepsinkeepingthecountryunderthestateofalertnessandpreparednessincaseofH5N1outbreak.

Thetrainingoftrainerswasdesignedtoenhancethecapacityofprovincialanddistrictagriculture,healthofficersandotherresponsiblekeyplayerstobeonthelookoutforanyincidentrelatedtodyingpoultryinlargenumbersandpeoplegettingsickfrominfluenza-likeillnessesinthecommunity.Thetraining,usingateam-basedapproach,specificallywasaimedatbuildingtheinterpersonal

A poultry trader transports live chickens in one of the local markets in Phnom Penh.


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communicationskillsoftherapidresponseteam:Howtogatherinformationfrompeopleinthecommunitythatisusedtoinvestigatetheoutbreakandhowtocommunicateaccuratelyandeffectivelyimportantinformationtothecommunityandcommunityleaders.

Ourlocalconsultant,Mr.TongngyKaingfacilitatedthepreparationforthetraining.TrainingwasheldattheSunwayHotelinPhnomPenhfromJune20to21.

Therewereeightparticipants:threefromCDC;threetechnicalstafffromNaVRI–allspokeandunderstoodEnglishwell;andtwoCambodianRedCrossrepresentatives,alsogoodEnglishspeakers.TheRedCross’seniorprogrammanagerevenhelpedmeonsimultaneoustranslationforthetwoparticipantsfromCDC.

ExceptfortherepresentativesfromtheCambodianRedCross,allparticipantsfromthetwoministriesaremembersofthesurveillanceandrapidresponseteam.Fromtheclassroomdiscussionitwasclearthattheywerefamiliarwiththeirrolesandresponsibilitiesandhowtoworktogetherinthecommunity.WeinvitedtheparticipationoftheCambodianRedCrossbecause

theorganizationservesasamemberoftheNationalCommitteeforDisasterManagement(NCDM)andithasH5N1virusactivitiesinselectedprovincesinthecounty.

IfollowedtheRiskCommunicationguidedevelopedforthePREVENTProject.Ifocusedonthreesections–FormingtheCommunicationTaskForce,WorkingintheCommunity,andCommunicatingEffectively–andincludedinterpersonalcommunicationskills.Ialsohighlightedtherapidassessmentchecklistwhichprovidedthemwithavarietyofquestionsthattheymayencounterwhentheytalkwithpeopleduringanoutbreak.

Weopenedthetrainingbyaskingthemasetofquestionsasapre-test.Thequestionswereformulatedbasedonthecontentoftheguide.Questions,however,couldbeansweredbasedonwhattheyencounteredinthefieldbeforeandduringanoutbreak.Basedonthereviewofthepre-testresults,oftheeightparticipants,sevenansweredwell.

Beforediscussionofthetechnicalsections,IgavethemscenarioswhichwereliftedfromrealhumancasesinCambodia.Weanalyzedthescenariosbyansweringsetsofquestionsandleadingtothetechnicaldiscussionin

After the training, these national trainers are expected to train the provincial and district rapid response team members.

Trainees analyzing scenarios.

A participant shares his video.


dyingbirdseveryday.Thefamilyburiedthedeadchickens,buttheirneighborswhoalsohaddeadchickenscookedthem.Herfamilywasafraidofcookingthedeadchickensbecausetheyheardaboutavianinfluenzaontelevision.

Oneteamaskedtheladyvendor,“Wheredoyougetyourchicken?Ifyoudonotraisethemyourselves,howdoyouensurethatyouslaughteredthehealthyones?Haveyouheardofdiseasesinchickenlikepraksaibaksai(birdflu)?”

Attheendoftheinterview,theteamlearnedthatthechickensellerwasnotawareoftheriskofavianinfluenzawhensheslaughterspoultry.Shenevercarestoprotectherselffrompossibleinfection.

Wespenttwohoursinthemarket.Backinthetrainingroomtheparticipantsdiscussedtheirexperience,identifiedtheirgapsandlimitations,andanalyzedthesituationstheyencountered.TheirexperienceinthefieldwillbeutilizedingroupsessionsandpracticeduringtheprovincialtraininginJuly2012.

Theteamfoundthemarketinterviewdifficultbecausetheydidnothavemuchtimetopracticethequestionsinthetrainingroom.ItwasmypurposenottogivethemmuchtimebecauseIwouldliketoobservetheir“usualpractice”beforemypresentationoninterpersonalcommunicationskills.Theyadmittedthatthefieldworkwasinterestingdespitethehotweather.

Mr.HangChansanafromtheCambodianRedCrossexpressedthatthemarketexercise,whichexposedthemtoasituationsimilartoapossiblediseaseoutbreak,wasanimportantpartofthetraining.Inthefieldwork,theywereengaged.Theylearnedby“doing,”ashecalledit.Andthesharingamongtheparticipantsoftheirexperiences,theirthoughts,andopinionswasveryeducationaland

myPowerPoint.Withthefourscenariosweused,theyunderstoodbettertheconceptsbeingpresented.

OneoftheparticipantswhojoinedthesurveillanceteaminKampongSpeubeforethepronouncementofthe21sthumancaseofH5N1sharedhisvideo–documentingtherapidresponseteam’sexperienceofcommunicatingwiththepeopleandaskingforvillagecooperationtocontainthedisease.

Asmybaseline–toobservetheirusualpracticeinthefieldingatheringinformationfrompeople–wehadafieldvisittotheCentralMarketinPhnomPenh.Idividedthegroupintotwogroups,witheachcomposedofonehealthofficer,oneagricultureofficer,onecommunicationofficer,andoneadministrator/logisticsofficer,asprescribedinthetrainingguide.Participantswereaskedtocomposetheirownscript,talkwithpeopleinthemarket,anddosomeinterviewsandpracticethemessagesfoundintheirtraininghandouts.Theoutcomewastohelpthemdeterminewhattheylearnedandifthereweregapsinhowtheytalkedtodifferentpeopleduringtheirinvestigation.

Theteamswereremindedofthebasicpremiseinriskcommunication.Theywereencouragedtoidentifythemselveswiththepeopleandtellthepeoplewhytheywerethere.

Theteamsinterviewedslaughteredchickenvendors,clothes/shoessellers,jewelryandgoldseller,travelers,andsugarcanejuiceseller.Theylearnedthatmostpeopleareawareofavianinfluenza;theyheardaboutavianinfluenzaontelevision.Mostofthepeopletheytalkedwithknewthebasicpreventionmeasuresbutdidnotknowthesymptomsofthedisease.

Thesugarcanejuicevendorsharedthatherfamilyintheprovinceraisedbackyardpoultry.Thefamilyexperienced

MID-BCC in Cambodia: Training the Frontlines on Risk Communication (Continued)


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informative.Theylearnedfromthediscussion.Talkingwithpeopleofdifferentbackgroundswasagoodexerciseforhimtolearn,headded.

Dr.SothearaNopoftheUSAIDMissioninCambodiacameintheafternoonontheseconddayandprovidedinputonhowthetrainerscouldfilltheknowledgegapsofhealthcareworkersontheclinicalsymptomsofH5N1infectioninhumans.Hestressedtheneedtoutilizethetechnicalinputofbothministriesandaddasessiononclinicalsymptoms(recognizingthesigns)ofthedisease.

Thetrainingparticipantshelpedinfinalizingthetrainingplanfortheprovinces–KampongSpeu,Battambang,KampotandBantayMencheay.

Inclosing,theyexpressedtheiralloutsupportfortheforthcomingprovincialtrainings.Forme,thisisnotyettheclosing–thisistheopeningofanopportunityforthemtocommendablyperformtheskillstheygainedfromthistraining.

Ifoundthethree-daytrainingverytoughbecauseIdidnothavemuchtimetofurthercoachthetrainers.ButIhavehighhopesthatthetrainerswillbeabletoimplementthetrainingplaninJuly.▪

This team asked the sales ladies if they heard about people getting sick of influenza – like illness. Two members of the team came from CDC and shared information about symptoms of H5N1 infection in humans.

The participants from the Cambodian Red Cross assisted Mr. kaing on logistics for the provincial training.

This team provided the poultry vendors with information on how to prepare poultry and to cook poultry meat well.

On the last day, the participants were excited to receive their training certificates.


MID-BCC in Cambodia: Training the Frontlines on Risk Communication, Part IIByCecileLantican|June28,2012

The following blog is the second part of the earlier post, MID-BCC in Cambodia: Training the Frontlines on Risk Communication.

WithsupportfromtheUSAIDMID-BCCproject,aftertheTOTinPhnomPenh,theeightnationaltrainersfromtheCommunicableDiseaseControlDepartmentofMinistryofHealth,NationalVeterinaryResearchInstituteoftheMinistryofAgriculture,ForestryandFisheries,andCambodianRedCrossplannedthecascadetraining.Themainpurposeoftheplanwastotrainprovincialanddistrictagriculturalstaff,veterinarians,hospitalhealthstaff,privateclinicians,pharmacistsandpharmacyclerks,andvillagevolunteersfromfourprovinces–KampongSpeu,Kampot,Battambang,andBantayMencheay.Theseprovinceshadahistoryofbirdfluoutbreaksandhumanfatalities.

OnJuly3,KhoukhamXaymounvongandItraveledfromLaoPDRtoPhnomPenh,CambodiatoprovidetechnicaloversightintheconductofthecascadetraininginKampongSpeu.Fromtheairport,wetraveledabout48kilometers,anhourdrive,beforewereachedtheProvincialHealthDepartmentwherethetrainingwasheld.Themainroadhasanexcellenttransportinfrastructure;before,itwasdirtroadin2008,myfirsttimetovisittheplacewiththeFAOteam.

KampongSpeuishometoasignificantnumberofmanufacturingandindustrialbases.Alongtheroad,wenoticedaboutathousandyounglaborers,mostlywomen,comingoutwithbannersfromagarmentfactory.Thedrivertoldusthatthesefactoryworkerswereleadingamassivestrikebecausetheyweredemandingraisesandbenefitsfromthecompany.

Theprovincerecordedapoultryoutbreakin2006andthefourthhumanfatalityfromH5N1inthesameyear.InMay

ofthisyear,theprovincealsoregisteredthe21sthumancaseofH5N1.

OftheeighttrainerstrainedinPhnomPenh,sixjoinedtheKampongSpeuteam.Theyarrivedattheprovinceonedaybeforethetrainingtopreparethemselvesanddiscussteamworkandhowtomanagegroupsessions.Ontopofthelogisticsupportwasourcoordinator,TongngyKaing.

Therewere38participants–17veterinariansand22healthstaff.Ofthistotal,therewerefourwomen(twoveterinariansandtwocommunityorganizersfromtheCambodianRedCross).

Attheendoftheday’ssession,Iseizedtheopportunitytoaskthetrainersaboutthemselves.Iaskedthemabouttheirimpressionsofthetraining–whatisfeasibleandwhatisdifficultforthem.

This is the kampong Speu Provincial Health Department office. The training was held on the second floor of the building.


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Ms.DimVanthaistheProjectOfficeroftheCambodianRedCrossCommunity-basedHealthandFirstAidProjectinKratieProvince.BeforeherstintwiththeCambodianRedCrosssheworkedinanorphanagemanagedbyalocalnon-governmentalorganization.

Shemanagesprojectactivitiesondiarrhea,dengueandmalaria,acuterespiratoryinfection,waterandsanitation,andmotherandchildhealth.Shefacilitatedthetechnicalsessiononinterpersonalcommunication.

“Myacademicbackgroundwasaccountancy.WhenIjoinedtheCambodianRedCross,Ireceivedtrainingonepidemiccontrol.OurtrainingonriskcommunicationatSunwaywasmyfirsttrainingoncommunication.AfterourtrainingIdidnothavetheconfidencethatIcouldbeatrainer.Myworkinthecommunitywasmoreofcoordinationwithlocalauthoritiesandpartnerstoimplementouractivities.IhadsomefearsthatImaynotbeabletomeettheexpectationsoftheteam.BeforeIleftforKampongSpeu,Ireceivedalotofproddingandencouragementfrommysupervisorintheoffice.”

Iaskedheragain,“Howdidyoufindhandlingtheses-siononinterpersonalcommunicationskillsorIPC?”Shereplied,“Itwasnoteasy.IwasfortunatetoworkwithMr.Chansanaonthissession.Heguidedmetodelivertheses-sion.Ilearnedfromhimwhowasmoreexperiencedinthiswork.Ireceivedadvicefromothertrainers,too.Ireallyappreciatedtheteamwork.Afteryesterday’ssession,Ifeltbetter.Fromothertrainers,Iunderstoodwellaboutthediseaseandourkeymessages.Isawothertrainersperform.Now,Ifeelmoreconfidenttodelivermynextsession.”

Mr.MakChantholhasservedasaprojectstaffofFAOCambodia.HewashiredbyFAOin2006andwasdeployedatNaVRItosupportthecommunicationneedsoftheinstitute.Hisacademicbackgroundwasinanimal

healthandproduction.HeisnowamemberoftheCommunicationTaskForceoftheDepartmentofAnimalHealthandProduction.HeleadstheavianinfluenzacommunityforumsupportedbyFAOandNaVRI.Hefacilitatedthesessionson:(1)theavianinfluenzasituationinthecountryandKampongSpeu,symptomsofAIinbirds,andpreventionof/protectionagainstthediseaseinbirds;and(2)FormingaCommunicationTaskForce–RolesandResponsibilities.

Mr.Chantholshared,“FromourTOTinPhnomPenh,Iwasamazedthatwehavemovedtheprovincialtrainingsofast.Earlyon,Ihadsomedoubtsthatwecouldgettheteam.Wehavedifferentlevelsofunderstandingthecontentareasofthetraining,anddifferentexperiencesconsideringtheofficeswecomefrom.Beforethetraining,theteamdiscussedslightchangesontheagendawhichweagreedonduringtheTOT.Asatrainer,Ibelieveweneedtolearnmoreineverytrainingwedo.Eachtrainingthatweconductshouldserveasanopportunityforustolearnmore.Ipersonallybelievethattraininginotherprovincesshouldcontinue,butthereisaproblemoflackofgovernmentfundstofinancetheactivities.”


Mr.HangChansanaistheheadoftheEmergencyHealthUnitoftheCambodianRedCrossandconcurrentlytheProgramMangeroftheCommunity-basedHealthandFirstAidProjectinKaratieprovince.Mr.ChansanaattendedtheAI-BCCinterpersonalcommunicationskillstraining

workshopthatwasconductedbyAEDin2008.AEDimplementedUSAID’sAI-BCCprojectinCambodiafrom2006to2008.Hefacilitatedtheroleplayandscenariosettingforinterpersonalcommunicationskills.

“Ifeelgreataboutourtraining.Thisisthefirsttimethatdistrictagriculturestaffandhealthstaffattendedanavianinfluenzatrainingtogether.WeattheRedCrosshavebeenadvocatingformoreengagementofthegovernmentpeopletomoveintoactionthe“OneHealth”concept.Thistrainingisessentiallyamanifestationofpromotingthisconcept.Iheardfromtheparticipantsthatthiswastheirfirsttimetobeorientedontheimportanceofcommunicationintheirwork.Indeed,itwasthefirsttimeinthisprovincethatdistrictstafffromtheanimalandhealthcenterstalkedabouttheissueofbirdflutogether.AstheIPCfacilitator,Iwashappytoseeparticipantscatchingupslowlywithourcommunicationcontent.Iwashappytoseethatthemembersofthetrainingteam,despitediversityofexperiences,sharedtheirideasandhelpedoneanother.TheCambodianRedCrossisalwaysopentoprovidecommunitymobilizationsupportforemergingpandemicthreatsoranyeventofdisaster.SinceAEDtrainedusonIPCin2008,wehavebeentrainingourownpeopleinthefield.However,sometimeswe’relimitedtodosobecauseoftheprojectdonorpriorities.”

Dr.SokSaryworksattheCommunicableDiseaseControlDepartmentofMOHasasurveillanceofficerandinvestigatorduringoutbreaksofavianinfluenza,diarrhea,H1N1,dengueandmalaria.HeprovidesoversightandsupervisiontotheKampongSpeuprovincialhealth

department.HeservedastheresourcepersonforthesessionsontheH5N1situationinPhnomPenh,symptomsofAIinhumans,andhowtoprotectoneselffromcontractingtheinfection.

“Iamamazedthatwewereabletoputtogetherinonemeetingtheagricultureandhealthstaffoftheprovince.Itwasourfirsttimetotrainthemlikethisandalldistrictsoftheprovincewererepresented.Today,wehavestressedtheimportanceforthemtocommunicate,andshareinformationimmediatelyonceasuspectedcaseofbirdfluoutbreakisprobable.Theattendanceoftheprivatecliniciansandpharmacyoperatorsandtheirclerkswasalsoimportant.Theytoohaveakeyroletoplayinreportingandreferringprobablecasesofbirdfluinfectioninhumans.However,Iamnotquitesurehowmuchtheycanrememberabouttheinformationweprovided.Two-daytrainingistoofast.Ourpeopleinthehealthdepartmentseldomgetupdatedontechnicalknow-how.Ihopetheybetterunderstandthecoursepurpose.Iamalsoconcernedthatafterthistraining,howwecanmonitorthem.Thisisanissuethatwehavenotsettledyet.”

MID-BCC in Cambodia: Training the Frontlines on Risk Communication, Part II (Continued)

Onthevenueofthetraining,Mr.Chansananoted,“Ihopesimilartrainingslikethisshouldbeconductedatthevillagelevel.Wecanobserveparticipants’reactionandperformancebetterinanenvironmentthatisclosetothem.”


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Mr.SemTharinworksintheLaboratoryInspectionunitofNaVRI.Duringthebirdfluoutbreakhejoinedthesurveillanceteamtocollectsamplesofdeadanddyingbirdsinthecommunity.TheTOTonriskcommunicationmadehimunderstandwhypeoplewerereluctanttocooperatewiththemduringanoutbreak.

“TheTOTmademerealizetheimportanceofthemannerweapproachthepeople,howwecommunicatewiththemwhenwegettheiranimalswithoutgivingcompensationinreturn.Imayhavetechnicalknowledgeaboutthevirus,butnevergotachancetoexplainitsdangertopeopleinamannerthattheycouldunderstanditandthereforewouldtakethenecessaryactiontoprotectthemselves.TheTOTcalledmyattentionhowtobemoreorganizedinmyfieldworkandlistentopeople.Ilearnedfromothertrainers.ButIlearnedmorefromthedistrictpeoplewhosharedtheirthoughtsandexperiencestoday.Durationforthetrainingistooshort.Giventhenumberofparticipants,weshouldhavedividedtheminmuchbiggerspacetoallowmoreinteractionamongthem.Itwastheirfirsttimetoexperiencethislearningprocess.Ithinktheyhavemoreideastoshare,especiallythosewhocamefromvillageswithH5N1outbreaks.”

TrainersinActionParticipantsweredividedintogroupsandweretaskedtodiscussandsharetheirinsightsonbasicconcepts–communication,interpersonalcommunication,usualhabits,andbehaviorchange.Thisisthelevelingoffexercisebeforethetechnicalinputsothattrainerswouldknowwhattheparticipantsknowandwhatdotheyunderstandaboutcommunicationintheircontextandexperience.

Theparticipantsdemonstratedhowtheycanmobilizecommunityleadersandjoinacommunityforuminaneventofanoutbreak.Intheroleplay,twomembersofacommunitycouncilusedcommunicationmaterialstostressthemessageofreporting.


Thescenarioalsodemonstratedhowinterpersonalcommunicationtakesplaceinagroupinteraction,makinguseofcommunicationmaterialswheretheremaybealargenumberofindividualsinvolvedinacommunicativeact.

Inasmallergroup,theparticipantsdemonstratedtheworkingrelationshipamongdistrictveterinariansandhealthworkerswhoweretaskedtocomposetherapidresponseteam.Inthescenario,oneparticipantwhoassumedtheroleofthecommunicationofficerfromthedistricthealthdepartmentshowedtheclearmessagethattheteamshouldrememberwhentheyshareinformationwiththecommunity.Thescenarioenabledtheparticipantstounderstandbetterthecommunicationrolesandresponsibilitiesoftherapidresponseteam.

Thisscenarioshowedhecommunicationactbetweenavillagechiefandavillageveterinarian.Themaninstripedshirt,thevillagechief,heardaboutreportsofdyingpoultryinhisvillage.Beingresponsibletohisvillage,hewasaskingthevillageveterinarian(maninwhitelongsleevedshirtwhoisarealagricultureofficerandknewH5N1)aboutthetechnicaldescriptionofsymptomsofH5N1.Thevillageveterinariandiscussedthesymptomsandsharedthemessageofpreventionagainstavianinfluenza.Oneobserverwastakingdownnotesontheconversationthatwastakingpace-notingtheaccuracyofthemessage,

MID-BCC in Cambodia: Training the Frontlines on Risk Communication, Part II (Continued)

listeningskills,skillsofquestioningandprobing,andnon-verbalcommunicationskillsofthevillageveterinarian.

Onthethirdday,wedidahalf-dayorientationofprivateclinicians,pharmacyownersandpharmacyclerks.Twenty-eightparticipantsattendedoutofthe20expectedinvitees.Therewere14malesand14females.Thepurposeofthisorientationwastoprovidetheparticipantswithcorrectknowledgeofthedisease,itssymptoms,prevention,andreporting/referralofcasesprescribedbythegovernment.Accordingtoreports,inmostofthehumancasesthatoccurredsince2006,patientsweremisdiagnosedwhentheysoughtmedicalattention.IrequestedTongngytohelpmeinterviewsomeparticipants.

TrainersinAction(continued)


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TongngyaskedDr.YemRun(ontheleft),62yearsold,whorunsasmallclinicinthetownabouthisimpressionoftheactivity.

“Ifindtheorientationuseful.TheinformationprovidedbothbythespeakerfromthehealthofficerfromCDCandtheagricultureofficerfromNaVRIisveryuseful.Thisismyfirsttimetohearsuchdetailsofthedisease.Inmypractice,Imostofthetimehavetreatedcasesofseasonalflu,butnotexperiencedseeingtheclinicalsymptomsofH5N1.”

WealsoaskedavillagehealthvolunteerwhocamefromToulSalavillage,Borsethdistrict.Thiswasthesamevillagewherethe21stcaseofH5N1inhumanshappened.

SheisMs.VenNem,(onleft)32yearsold,whohasbeenavillagehealthvolunteerforalmostfouryears.Shesharedwithus,“Therewasinformationaboutbirdfluinthevillage.Togetherwiththedistricthealthoffice,wewarnedthepeople,buttheydonotlistentous.The21stcasewasarelativeofmine.Now,myfamilyhasbeencareful.Thismeetingisveryusefultome.Ihavelearnedmanydetailsaboutthesymptomsandhowtoprotectourselves.”

Thisyoungladyvolunteeredtotalkwithus.SheisSaingChanNoun,22yearsold,andworkingasapharmacyclerk

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withherauntiewhorunsadrugstoreinthevicinity.Sheexpressedthatthisorientationwashelpfulandimportantforher.Basedonherexperience,peoplejusttellherthemedicinetheywanttobuy.Giventheinformationonthesymptomsofthediseases,shewasnowawarethatsheshouldaskclientsfirstabouttheirproblembeforesellingthemthemedicinethatisaskedfor..

Wrappingup!Thesuccessofconductingtheriskcommunicationtrainingdependsonmanyfactors--preparation,logistics,teamwork,learningenvironment--butmoreimportantconsiderationsarethebackgroundandtrainingskillsofthetrainers.IntheKampongSpeutrainingexperience,thetrainersexertedeffortonshowingwhattheycandelivertomakepeopleunderstandhowtocommunicatetheriskofH5N1indifferentways.Insimpleroleplaysofoutbreakscenarios,theyshowedhowinterpersonalcommunicationoccurswithinothercontextslikegroupsandorganizations.Seeingthetrainersinaction,Ibelievetheirinterpersonalcommunicationskillscanbeimprovedthroughknowledge,practice,feedback,andreflection.

Atlunchtime,wehadourtasteofCambodianexoticfoodinanearbylocalresort.Wewaitedformorethan30minutesbeforethechefwasabletocookourfood.Thelunchwassumptuous.However,weweresurprisedbythecomingofonemoreguest.▪

Here she is, the next topic of my blog, maybe in my next visit to Cambodia.


High Risk Communication Training In Battambang, CambodiaByDeeBennett|July27,2012

TheMID-BCCProjectisconductingaseriesofriskcommunicationtrainingsforanimalandhumanhealthdistrictandprovincialprovidersinfourprovincesinCambodia.DeeBennett,MID-BCCProjectDirector,andTrudyFarnum,OperationsManager,visitedtheBattambangProvincetrainingheldon17-19July,2012.TheytraveledfromSiemReapandPhnomPenh,respectively,andmetwithTongngyKaing,MID-BCC'sprogramconsultant,wheretheyreviewedlogisticsaswellasobservedthetraining.FollowingisablogbyDeeonobservationsandoverviewofthistrainingactivity.


Battambang,CambodiaBattambangisabustlingandboomingtown.Constructioniseverywhereandsemisrollthroughtownatalltimesofthedayandnight.Icanhearthemrollingthroughtownbecauseweareonamajorthroughroadandthedriverssoundtheirairhornsat2a.m.asifitwere2p.m.UnlikeSiemReap,whichischarmingandbasedonatouristeconomy,thereisenergyandacommerce-feelinBattambang.

WhenwearrivedintownIgotoutofthecartohearaCalltoPrayerfromthelocalmosque.Hadtoadjust....notsome-thingI’musedtohearinghere.ItalsowasthesittingforthenationalexamsforKhmerschoolstudents.Iheardamikedannouncementremindingstudentsastheyreturnfrombreak–“Nopapers.Nodocumentsonyourbodies.”Inotherwords,nocheating.Severalparticipantsattheworkshophavechildrentakingtheexamssotheyareanxiousforthem.

WorkshopTongngyKainghasdoneanexcellentjobonlogistics.Thehotelisnewandefficient(Chinese-fundedandKhmer-

Temple near the hotel is a mixture of Hindu and Buddhist. yes, it is disconcerting to see Buddha with Ganesh.

built)andwearebasedinalargeconferenceroom.Itgivesusroomtoaccommodatethe38participantsplusseventrainersandourstaff,aswellasanareatobreakintoworkgroups.Thehotelstaffisveryefficientandaccommodating.

Theworkshop’sinitialpurposewastopreparehumanandanimalhealthworkersonriskcommunicationbecauseofthenewoutbreaksofH5N1virus.However,aswehavedevelopedtheworkshops,thereisadditionalvaluetowhatwearedoing.

First,thesetrainingshavebroughttogether–andinsomecasesforthefirsttime–providersfromtheDepartmentofAnimalHealthandMinistryofHealth.Lotofemphasishereplacedonthathappening.Thesetrainingsarefocusedoncommunicationanditisexcitingtoseeitisnotanafterthoughtoradd-on.Itisoncenterstage...andthat’snice.

Thisisacommunity-levelactivity.Itreachesprovidersthatareonthefrontlinesandgenerallydonothaveaccesstotraining(especiallyoncommunication)ortocurrentinformationandmaterials.Participantscamefromasfarawayas130kmandrepresentcommunesanddistrictsfromthroughouttheprovince.

AndintheendtherewillbeexperiencedKhmertrainersthatareequippedtodothistraininginotherprovincesandforotherpublichealthissues.


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–butalsounderscorestheneedforpreventativemeasuresandplans.

BeforewecametoCambodiatherewerereportsofthemysteriousdeathsof60-plusKhmerchildren.Thesedeathshavedrawnworldwideattentionasauthoritieshavetriedtosortoutwhatiscausingthem.Therehavebeenspeculationsandhypothesesamong"experts"butuntilthegovernmentofCambodiawithWHOmakeastatement,itisstillupforprofessionalopinion.

QuickSnapshotAssessmentTheseventrainerscomefromthegovernmentofCambodia–twofromtheCentersforDiseaseControl(MoH)andthreefromMinistryofAgriculture,ForestriesandFisheries(MAFF)–andtwofromtheCambodiaRedCross.Theyareoverallexperiencedtrainers.OnepersonfromMAFFactuallyworkedwithAI-BCCearlyoninCambodia.ForthistrainingthemastertrainingwasconductedinPhnomPenhbyCeciliaLantican,countrycoordinator,LaoPDR,MID-BCC.NoiXaymounvong,amemberofourtechnicalstaffinLao,observedthefirsttwotrainings.Thetrainerssaidtheyfeltmoreconfidentintheirtrainingwitheachevent.And,theyfeelthatthey

WhenyoucomparetheseaccomplishmentstowhatUSAIDForwardwantstoaccomplish,itisimpressive.Thesetrainingswillleadtosustainabilityanditisbuildingcapacityofpartnersandcounterparts.

Theattentiontowomen-focusedactivitiesandgenderisnotthere.Weshouldlookatwhatkeepswomenfromparticipating.Isitfamilyresponsibilities,beingawayfromhome,notinpositionofresponsibility,senority?Weneedtoseehowwecaneasethoseobstaclessomorewomenareincluded.

OneHealthandOtherHealthIssuesThetrainingsessionwasopenedbyChouSeuth,TechnicalHeadOfficerofBattambangPublicHealthOffice,andLongPhorn,BattambangAgricultureProvincialDeputyDirector.Wehad17vetsfromMAFFand18healthofficialsfromMOH.

TheconceptofOneHealthwaskeyinthewelcomingstatementsbythegovernmentofficials.ASEANjustmetinCambodiathispastweekandcommunicationwasakeyfocusaswas“OneHealth”andmultisectoralcollaboration.OneHealthwasthebuzzamongthetrainersbecausethisworkshopisactuallydoingit.

ThevetsandhealthprovidershavebeenworkingindistrictsandmostarefamiliarwiththeH5N1virus.CambodiahashadaresurgencethepastyearincludingthedeathsofseveralKhmer.ThesedeathsandoutbreakshaverenewedaninterestinH5N1prevention–whywearehere

The seven trainers, above, joke and strike a pose for the camera, below.


High Risk Communication Training In Battambang, Cambodia (Continued)

havegrownwitheachone.Youcanseeitinthewaytheyconductthesessionsandalsointheirownershipofthemeeting.

Myworryinanytrainingistoomuchlecturingandnotenoughinteractionorinvolvementbytheparticipantsbecauseyoudon’tlearnwhenyouareboredornotengaged.Itiseasyevenforthebestandmostinteractivetrainingforboredomtosetin.ItisveryWesterntowanteveryonetoparticipate...notsomuchinothercountries.Thereisparticipationlatemorning.Ithinkitneedstomoveupearlierandrecommendedmovingoneoftheafternoonactivitiesearlyinthemorningtohearfromtheparticipantsearly.

Thereislotsofon-the-groundexperienceinthisroomandweshouldtakeadvantageofit.

Intheend,wewanttohelpthemdotheirjob.

FortheAmericanPeopleUSGisveryexplicit.TheyarethestewardsofU.S.taxpayers’moneyandtheywantqualityproductsandservicesforbargainbasementprices.Theirnameisonit:USAIDandinthecaseofUSAIDtheynotethatitis“FromtheAmericanPeople.”AmericanPeopledon’twanttopayforjunk.Theyalsodon’twanttobreakthebank.FindingthatbalancemakesusallintogreatbargainersandalsodiscernersofgoodproductsthatUSAIDandUSGcanbepleasedtosayitisFromtheAmericanPeople.

Thisconceptisaworkinprogress.

WhatisNextInourdebriefIaskedthetrainerswhattheywanted.Theywantedthreemainthings:

1.Thetrainingextendedtoall24provinces.Wecanask,butif dependsonfundingandfocus.I’mwillingtoraiseit

2.Refreshertraining.Thatone’seasy.Ourstaff willbeinCambodiaforthenexttrainingandshewillalsoconductarefreshertrainingforthetrainersattheendof thetraining.

3.OneHealthandmulti-sectoralissuesconveningunderanadhoccommunicationcommittee.Thisislessof aquestionbutaheadsup–communicationisnowpartof anadhoccommitteethatintwoyearswillbecomeapermanentcommittee.HavingtheseskillsandexperienceisabenefitforCambodiaandcontributestoOneHealth

HelmetsAlawhasbeenpassedinCambodiathatscooterdriversmustwearahelmet.Isawpolicepulloverayoungwomanonascooterwhodidnothaveonahelmet....herexpressionwasclassic.Sheknewshehadbeencaught.

Problemwiththelawisthatitdoesnotspreadtothepassengersonthescooters.Soyoucanseeafamilyoffouronascooterandthedriverwearingthehelmet.

Greatpolicy–liketoseeitextendtopassengers,too.

TeamBirdFlu:SoccerinCambodiaMostweekends,TeamBirdFlucanbefoundcompetinginafriendshipsoccermatchinPhnomPenh,Cambodia.The


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teamwasoriginallyestablishedin2007asTeamLawyer7,butbecameTeamBirdFluinMay2012topromoteawarenessofavianinfluenzaandpreventionmeasurestothepublic.USAID,throughtheFHI360CambodiaOffice,fundednewteamuniformsfeaturingthe“SuperChicken”logodesignedunderUSAID’sAI-BCCproject,thepredecessortoMID-BCC,andrevivedforMID-BCC’scurrentwork.▪

ChantholMak,theteamcaptainwrotethefollowing:

OnbehalfofBirdFlufootballteam,IworldliketosaythankyouverymuchtoUSAID/FHI360forsponsoringourteamandIhopethatUSAIDwillcontinuetosupportourteamactivitiesinthefuture.

Welcomeeverybodytobecomeourteammates.

TeamplayeveryweekendonSaturdayorSunday.

Withbestregards,C.MakBFTrepresentative29May2012

Team Bird Flu in their new uniforms

USAID, through FHI 360, provided 287.50USD for the new team jerseys. The “Super Chicken” Logo on the front reads “Only you can stop Bird Flu”.

Team Bird Flu in action in a friendship match against Team Fed Ex May 26, 2012 in Beng keng kang, Phnom Penh, Cambodia. Team Bird Flu was defeated by Team Fed Ex by a score of 4-3.


CecileLantican,Ph.D.,MID-BCCCountryCoordinatorLaoPDR,supportedateachertrainingontheLaogovernment’sGuidelinesonPreventionofInfectiousDiseasesinSchoolinLuangPrabangMay21-23.Theworkshopwasattendedby32teachers,schooladministratorsandhealthcareworkers.


Inourpastcommunity-basedactivitiesinLaoPDR,welearnedthatthevillageteacherasacommunityleaderisatthecenterofcommunitydevelopmentactivitiesamongvillagepeople.Thevillageteacherisabletomotivatepeopleandearnsrespectinthecommunity.

Whatistheroleofteachersinpreventingthespreadofinfectiousdiseasesandreducingpossibilitiesofdiseaseoutbreak?ThisisaninterestingquestionwithaninterestinganswerthatIwouldliketosharewithyouthistime.

DuringthefirstthroughthethirdweekofMay,MID-BCCassistedtheNationalEmergingInfectiousDiseasesCoordinationOffice(NEIDCO)inBokeo,LuangNamtha,andLuangPrabangintrainingschoolteachersinkeymessagesandtechniquesfordiscussingcommunicablediseasesamongstudentsinsecondaryandhighschools.InLaoPDR,theageofstudentsinthesecondaryschoolrangesfrom11to13yearsold,whilethoseinhighschoolare14to17yearsold.

OurmainpurposeinprovidingtechnicalassistancetoNEIDCOwastoexpandthediscussionofinfectiousdiseasesthroughtheeducationsector.Theeducationsectorisamemberofthemulti-sectoralgroupwhichhassupportedthenationalplanandstrategyforinfectiousdiseasesof2011-2016.Throughthisintervention,wewould

One Community, One School, One HealthByCecileLantican|June4,2012

likealsotohelpimprovetheinterpersonalcommunicationskillsofteachers---helpthemstepbeyondtheusualinstructionalmethodologyofprimarilylecturingtostudentswhositinrowsatdesks,dutifullylisteningandrecordingtowhattheyhear.Improvementoftheirinterpersonalcommunicationskillswouldhelpthemtoconfidentlyandaccuratelydeliverthekeymessagesofinfectiousdiseaseprevention.

FromthegainsofavianinfluenzaandH1N1experience,thegovernmentofLaoPDRcameupwiththeGuidelinesonPreventionofInfectiousDiseasesinSchool.Theguidelinesprovidegeneralprinciplesandguidancetoschooladministratorsandteacherstoopendiscussionofinfectiousdiseasesinclass.Italsoprovidessuggestedactionsforhowtopreventinfectiousdiseasesintheschool,andhowtomanageandreportcasesofinfectiousillnessestothehealthcarecenterorhospital.Theguidelinesdiscuss30infectiousdiseases,amongwhichincludeavianinfluenza(H5N1virus),H1N1virus,denguefever,andmalaria.TheactivitywasstronglysupportedbytheMinistryofEducationandSports(MOES).


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NEIDCOcommissionedthenationalIECTaskForcetoleadathree-daytrainingforteachersandofficialsinthreeprovinces–Bokeo,LuangNamthaandLuangPrabang.IjoinedthenationalteaminLuangPrabangonMay21-23.

ItwasrainingwhentheplanetoucheddownattheLuangPrabangairport.ItwasthesameweatherwhenourteamvisitedLuangPrabanglastyearinJulytoconductthecommunityleaderstrainingatthecrossborderdistrictofPhonexay.

OurfirststopwasattheofficeoftheProvincialEducationDepartment.WehadabriefingwithMrs.VannaPhomsy,DeputyDirectoroftheLuangPrabangEducationDepart-ment.Sheexpressedherwarmwelcometousandsharedthatherdepartmentwaspreparedtohostthetraining.

On my left side was Mrs. Phomsy, the director of the high school division of Santhiphab School, before she became the provincial deputy director.

The city, so quiet before sunrise, while waiting for the gong tolls that signal the coming out of the monks from the temples.

Mrs. Phomsy’s office is in one of the rooms on the second floor of this building, the training center of the Provincial Education Department, located within the school grounds of the Santhiphab public school. The training was conducted on the ground floor.

LuangPrabangwasoneofthepriorityprovincesoftheAI-BCCProjectin2006.Itsairportservesbothdomesticandinternationalflights.Thegovernmentmarkeditasacriticalpointofentryforinfectiousdiseases.

UnderMID-BCC(fundedbyUSAIDRDMA),wehavecontinuouslyprovidedassistancetotheprovinceonriskcommunicationforavianinfluenzaandotherinfectiousdiseases.MID-BCChasestablishedalong-standingrela-tionshipwiththeprovincialDepartmentofAgricultureandForestryandprovincialDepartmentofHealth,firstengag-ingdistrictstafffrombothsectorstotrainandmobilizecommunityleaderstoreducetheriskofavianinfluenzaandpandemicH1N1in2009.ItalsotrainedtheLaoWomen’sUnion’sLuangPrabangchapterontheuseofSMStechnol-ogyinmonitoringandreportingdiseaseoutbreaks.


One Community, One School, One Health (Continued)

ThistechnicalassistancetoNEIDCOwasourfirstdirectengagementwiththeprovincialeducationdepartment.

TheprovinceisinthecentralnorthofLaoandsharesaborderwithVietnam.ItisaUNESCOWorldHeritagesite,andisahometoHmong,Khamu,TaiLue,andLaoethnicgroups.

ThecityisknownforitsnumerousBuddhisttemples,monasteries,andFrenchcolonialarchitecture.Earlymorningeveryday,hundredsofmonksfromthevariousmonasterieswalkthroughthestreetscollectingalms.

TheTrainingTherewere32participants,equallydividedbetweenteachers,schooladministratorsandhealthcareworkers.Theyrepresentedfivedistrictsoftheprovince.Oftheseparticipants,sevenhealthcarestaffhadattendedtheAPI(avianpandemicinfluenza)andH1N1influenzavirustrainingconductedbyusin2009.Ofthe32participants,11werewomen.Intheprovince,therewasanobservedgapbetweenmenandwomenintermsofequalopportunitiestoassumeapositioninthegovernmentservice.

ThetrainingwasofficiallyopenedbyMr.KhamPhoneSibounheang,ViceDirectorofthecabinetoftheMinistryofEducationandSports(MOES).Heunderscoredtheimportanceoftheactivityinrelationtotheministry’sstrategicobjectiveofbeinggloballycompetitive.Themakingoftheguidelinesforinfectiousdiseasesinschoolwasstronglysupportedbythenationalleadership.

Hence,hesaid,“Theguideline’simplementationshouldnotonlymanifestresultsamongourstudentsinschools,butalsotranscendtheknowledgeandpracticeofinfectiousdiseasespreventionincommunitieswheretheylive.”DeputyDirectorMrs.VannaPhomsywelcomedtheparticipantsandputincontextthepurposeofthetraining.Theschoolandteachershaveabigroleinreducingtheriskofinfectiousdiseases.

“WecanproducemoreeducatedcitizensofLuangPrabangifwekeepourstudentshealthy.Ourschoolshouldprovidetheenablingenvironmenttoprovideknowledgeandpracticeofgoodhealth–thekeytoproducinghealthystudentsandgoodteachersinthefuture,”shestressed.

CIEHDeputyDirectorMr.PhoumyBodhisaneprovidedthelinkofthisactivitytothenationalplanandstrategyforinfectiousdiseasesof2011-2016.

TheleadfacilitatorswereMs.WassarinhChounlamanyandKhounkhamXaymounvong.

Participantsweregroupedtogether–schooladministratorsandteacherswithhealthcareworkers.Thehealthcareworkersprovidedthetechnicalguidanceforthediseasesbeingdiscussedwhiletheschooladministratorsandteachersidentifiedwaysandstrategiesthattheycanintegratetheinfectiousdiseaseguidelinesintheclassroomandoutdooractivitiesofthestudents.

Atteabreak,Ihadtheopportunitytointeractwiththepartici-patingteachers.Ilistenedtotheirexpectationsofandreactionstothetraining.Fromtheirstories,Ialsogatheredsomeinsightsaboutteachereducationandtheprofessioninthiscountry.

TheeducationsysteminLaoPDRisgradeandcurriculum-basedandreliesontextbooks.Teachersuselessonplanstofacilitatestudentlearning.Thus,inthistraining,schooladministratorsandteacherswerechallengedtoidentify


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strategiestointegratetheguidelinesoninfectiousdiseasesintheircurriculumandlessonplans.

Acharn(whichmeansteacher)ChantoneSouriyateachesgeographyandhistoryinthedistricthighschoolofPhonexay.Heteachesmorethanonesubjectbecausethenumberofteachersinthedistrictisnotenoughtocover800studentsfromyearsixto12.

IaskedAcharnChantone,“Howdoyouintegrateinfectiousdiseasesinyourhistoryandgeographyinyourclasses?”Hereplied,“Inhistory,studentslearnaboutpastandcurrenteventsthatcreatedimpactontheirlives,inthesociety.Pandemicoutbreaksalsobecomepartofhistory.Butwedonotteachstudentsonlytorememberhistory;weencouragedthemtobemorecriticalofhistoricalepisodesanddrawlessonsfromtheseevents.Ingeography,ourstudentslearnedplacesandcommunitieswhereweliveandwork;whychangesoccurinourcommunities;howourindividualandsocietalactionscontributetothosechanges.Alongthispremise,Iwouldsay,ourstudentscanmakechoicesinmanagingtheirhealthfortheirfuture.”

IinterviewedAcharnBounlathSlilath,whohasbeenthedistricteducationsupervisorinNambakfor15years.Hewasanelementaryclassroomteacherfor11yearsbefore

hebecamedistrictsupervisor.Todate,hesupervises400teachersinelementaryandhighschools.Heprovidesoversighttoteachers’performancein86primaryschools,fivesecondaryschools,andthreehighschools.

AcharnBounlathsharedthatallteachersareobligatedtoupdatetheirlessonplans.Integrationofthepreventionmeasurestolessonplansbyallteachersunderhissupervisionwouldbenefit16,604students.

In2008,Nambakdistrictrecordedabirdfluoutbreakinducks.AI-BCCtrainedcommunityleadersastrustedsourcesofinformationonbirdfluin2009.Inthesameyear,wealsoreachedouttothisdistricttohelpinthegovernment’sH1N1vaccinecampaign.IwastryingtoimagineandcomparethereachofteachersunderAcharnBounlath’ssupervisionversusourtechnicalassistancetotrainselectedcommunityleaders.

IalsohadthechancetomeetAcharnSounthoneKeosovan,theDirectoroftheHighSchoolDivisionofSantiphabSchoolinLuangPrabang.Thisisthenationalandbiggestpublichighschoolintheprovince.AcharnSouthonewasahighschoolteacherfor10yearsinSanthiphabSchoolbeforehebecametheDirector.Hestillteachesbutassumeslesserteachingloads.

Our team was composed of (from left): Ms. Siphay vongsautham from CIEH; Ms. Wassarinh Chounlamany from MOES; Mr. kham Phone Sibounheang, vice Director of Cabinet of the Ministry of Education and Sports (MOES); Cecile Lantican from FHI 360; khounkham Xaymounvong, FHI360 training specialist; and Mr. Phoumy Bodhisane, Deputy Director of CIEH under the Ministry of Health.


IaskedAcharnSounthone,“Howdoyousustainmotiva-tionofyourteacherstointegrateintheirperformancethistypeoftraining?”Hisanswer:“Asaschooladministrator,Ialwaysconsiderandincludeintheteachers’development/trainingprogramtheirattendanceinthistypeoftraining.Therefore,wehaveawayofmonitoringtheirperformanceafterthetraining.Also,Iaminvolvedinupdatingourhighschoolcurriculum.Assuch,Icanrequestthesetrainedteacherstoshareandre-echoabouttheirexperiences.IbelieveitisnotdifficulttointegrateinfectiousdiseasesinourworkbecauseHEALTHandEDUCATIONarelinkedtogether.”Hedidnothaveachancetoelaborateonhisstatementbecauseteabreakwasover.

Imagineaschoolwheretheeducationalenvironmentisn’tconfinedtotheclassroom,butinsteadextendsintothehomeandthecommunityandaroundtheworld.Informationoninfectiousdiseasesisn’tfoundprimarilyinbooks;it’savailableeverywhereinbitsandbytesfromconcernedsectors.

Iwasonceateacherinmyowncountry.Ipersonallybelievedthatthisinterventionwasoneexampleofinstructionalinnovation.Teachersshouldbeawarethatthecurriculummustrelatetostudents’everydaylives.

MyinterviewwiththeteachersofLuangPrabangmademereflectonthehundredsofteacherswhowererethinkingeverypartoftheirjobs–howtoensurethehealthoftheirstudents,theirfamilies,andthecommunity;thetoolsandtechniquestheyemploy;andtheformandcontentoftheircurriculum.

Theirroletokeepthestudentsandcommunitysafefrominfectiousdiseaseswasanenormouschallenge.IwasagainremindedoftheTowardsaSaferWorldframework.ThekeywasINTEGRATION.Teachersandtheschoolinthisprovinceweredutyboundtointegrateintheirjobstheguidelinesoninfectiousdiseasesastheyguidetheirstudents’abilitiestoseek,understand,anduseknowledge;tomakebetterdecisionsintheirpersonallives,andtovaluecontributingtosociety.Butwhatpreparationdotheyneed?

Dr.BounlayPhommasack,DirectorofNEIDCO,waspresentontheseconddayofthemeetingandmadeanappealtoalltheparticipants,especiallytoteacherstopreparetheschoolandthecommunityforanypandemicthreatfrominfectiousdiseases.HedidnotmakespecificrecommendationsonpreparationmechanismsbutIamconfidentthathewasthinkingofthecreativityoftheeducationsectoronhowtotranslatetheguidelinesintoactionandmakethesedoableandoperationalintheschoolsystem.Regardlessofotherissues,teachersinLuangPrabangwouldseethemselvesnownotonlyasmastersofsubjectmattersuchashistory,math,orscience,butalsoteacherswhowouldincreasinglyinspirestudentsandthecommunitytobefreefrominfectiousdiseasesandhaveahealthylife.▪

This is the Santhiphab school ground. Acharn Sounthone provides oversight to a teaching force of 193 teachers from year six to 12, with a student population of 3,600.

Interviewing Acharn Bounlath Slilath

Interviewing Acharn Sounthone keosovan

One Community, One School, One Health (Continued)


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Strengthening the Risk Communication Capacity of Cross-Border Provinces: Savannakhet and Champassack ByCecileLantican|June2012

A resettled community at the border of Luang Namtha and China. This community depends on swidden farming for livelihood. Health care services are not readily available in the village.

This is part of the Thai-Lao Frienship Bridge on Savannakhet side.

This is the Chong Mek - vang Tao checkpoint from the Thai side.


Riskcommunicationisanessentialelementofdiseaseoutbreakmanagement.Inthe2011–2016LaoPDRNationalPlanoninfectiousdiseases,riskcommunicationisoneofthestrategiestomaketheplanoperational.

LaoPDRisalandlockedcountrythatsharesporousborderswithChina,Vietnam,Thailand,CambodiaandMyanmar.Thelegalandillegalcrossingoffoodproducts,animalsandpeopleacrosstheseborders,coupledwiththechallengeofgeographicalisolation,heightentheriskofinfectiousdiseasestransmission.

Mostpeoplearepoorandmanyliveinremotemountainareas,makingthemhardtoreachforintervention.Anoutbreakismorelikelytohappenaroundurbancitieswheredensitiesofhumansandpoultryarehighandmovements

ofpeopleandpoultryarefrequent.However,poorpeopleareoftenamongthosemostvulnerableandbearthemostsevereconsequencesofanoutbreak.

TheLaogovernmentwasasignatorytothe2001MekongBasinDiseaseSurveillance(MBDS)cooperationalongwiththefollowingcountries:Cambodia,China,Myanmar,Viet-namandThailand.ThisMekongcross-bordercooperationwasaimedtoacceleratethepreparednessofthesecountriesthroughstrengtheningcollaborationinrelationtopublichealthemergenciesofinternationalconcern.

Thetwoprovincesinthesouth–SavannakhetandChampassack–shareborderswiththeprovincesofMukdahanandUbonRachataniinThailand,respectively.ThepointofentrybetweenSavannakhetandMukdahanistheThai-LaoFriendshipBridgeNo.2,whereastheChongMek–VangtaocheckpointconnectsChampassackandUbonRachatani.


TheUSAIDfundedMID–BCCProject,or“CommunicationsinChangeforInfectiousDiseaseinGreaterMekongSubregion,”hasbeenprovidedfundingtoworkwithpartnerstoimplementaprogramfocusingonreducingoutbreaksofavianandpandemicinfluenza(API),malaria,dengueandotheremergingpandemicthreats(EPT)intheGreaterMekongSubregion(GMS)countries,includingLaoPDR.

SavannakhetandChampassackwereamongtheprovincesthatdemonstratedamodelofaneffectivecross-bordercollaborationinvolvingothersectorsapartfromhealth.Since2004,SavannakhetandChammpasack(withtheircounterpartThaiprovinces,andMukdahanandUbonRatchatani,respectively)haveimplementedcross-borderinformationexchangeoninfectiousdiseases.Onavianinfluenzaandpandemicpreparedness,theyimplementeda24-hour,weeklyandmonthlyreportingregardingdeathsofchickenorunusualeventsinpoultry.Theprovincialhealthdepartmentsofthetwinnedprovincesinitiatedcapacitybuildingoftheirhealthstaffondiseasesurveillanceandoutbreakresponse.

InNovember2011,MID-BCCsupportedatwo-dayinformationsharingworkshopamongthefourprovinces.Thisactivityallowedtheprovincialhealthdepartmentsofthecross-borderprovincestoshareinformationabouttheircommunication-relatedactivities,materials,andmessages.Theactivitywasenvisionedtostrengthenthedistrictlevelcapacity/relationshipforcross-bordercollaborationonsurveillanceandresponseforsignificantcommunicablediseasesintheGMS.

Duringtheseworkshops,participantsidentifiedtheirneedforatrainingonriskcommunication.Participantsexpressedthatbetterunderstandingofriskcommunicationprinciplesandplanningpracticesbetweenthetwocountrieswillfurtherstrengthenandsustainthesharing

Strengthening the Risk Communication Capacity of Cross-Border Provinces: Savannakhet and Champassack (Continued)

ofinformationonavianinfluenzaandotheremerginginfectiousdiseases.

FromMay29toJune1,Iandmycolleagues–KhounkhamXaymounvong,SiamphoneMahindorathep,andRujitaPanyeefromourRegionalOfficeinBangkok--facilitatedariskcommunicationtrainingforselectgovernmentstafffromSavannakhetandChampassack(Laoside)andMukdahanandUbonRachatani(Thaiside).Thetrainingwasaimedtopreparemembersofthesurveillanceandinvestigationteamstoplanacommunicationresponse---effectivelycommunicatecontrolmeasurestocontainanoutbreakandpreventitsfurtherspread.

Thefirstbatchoftraining(onMay29-30)withtheChampassackandUbonRachataniprovinceswascomposedof20participants,with10participantsfromeachprovince.Participantsweremostlymedicalstaffandveterinarians.Theywereselectedbasedontheirfunction

Champasack Health Department Deputy Director (Right). Dr. Somkiet voralat (Left)gives his welcome remarks.


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androleinthecrossbordercollaboration.Somewereepidemiologistswhoweremembersoftheprovincialsurveillanceteam.

Thesecondbatchfollowed(May31toJune1)withthesamenumberofparticipantsfromSavannakhetandMukdahanprovinces.Thesameselectioncriteriaforparticipantswerealsofollowedforagroupof10participantsfromeachprovince.

ComparedwiththeinformationsharingdoneinNovember2011,thereweremoreparticipantswhorepresentedtheprovincial/districtagriculturedepartmentsthistime.

ThetrainingswereofficiallygracedbytheprovincialhealthofficersofChampassack,DeputyDirectorDr.SomkietVoralat,andSavannakhetPHODirectorDr.PanomPhongmany.

Participants in the 2011 information sharing workshop compared and reviewed each province’s available materials on avian influenza and H1N1 virus.

FHI360 staff, Rujita Panyee and Siamphone Mahindhorathep

IusedtheRiskCommunicationtrainingguidedevelopedbyFHI360.Theguideappliesateam-basedapproachsuchasbuildingtheCommunicationTaskForce(orateam),explainstheresponsibilitiesofeachteammember,andprovidesdirectionsonhowtodealwiththecommunityduringanoutbreak.

Themorningsessionofthetrainingstartedwiththeriskcommunicationplanningprinciples,withfocusonformingacommunicationtaskforceandworkingwiththecommunity.Participantsweredividedintogroupstocomposeacommunicationtaskforce,withthehealthcareworkersandveterinariansfairlydistributedamonggroups.

Thetaskforcemembersweremadetounderstandabouttheirrolesandresponsibilities.UsingtheWHOrapidassessmentchecklist,participantswerepreparedonimportantquestionsfromcommunities/peopleduringanoutbreak



Mostoftheparticipantswerealreadyfamiliarwithepidemiologicalinvestigationofanoutbreak.Thetraininghowever,hasbroadenedtheirunderstandingofcommunicationprinciplesandskillsthatcouldenrichtheinvestigation.

Iputemphasisonthecommunicationskillsof“listening,askingquestionsandprobing,useofsimplelanguage,anduseofcommunicationmaterials,”whicharecentraltotheprocessofriskcommunication.Acquiringsuchskillscouldhelpthemasmembersofthesurveillanceandinvestigationteambetterunderstandcommunityperceptionsandcommunityinformationneeds.Theavianinfluenzabookletwasusedasanadditionalreferencematerial.

Aspartoftheexercise,theparticipants(inteams)werefieldedinthecentralmarketsandbusstationsofthetown.Theyweretaskedtotalkwithcommunitypeople--toapplythetheoriesandprinciples,andpracticethekeymessagesdiscussedinthetrainingroom.

Eachteamwasallowedtoidentifyandselecttheirtargetaudienceandpracticeagivenscenarioofgatheringinformationintheeventofanoutbreak.Theexercisewasvideotaped.Belowaresomeofthescenesinthemarketandbusstations.


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This team conducts dialogue with a poultry trader in the market. The lady trader gets her chickens from different sources. Since 1995, she has been selling birds every day in this market. The team asks her, “What did you do with your birds one year ago when there was a bird flu outbreak in the district?” The lady trader replies, “I did not sell chicken during the outbreak. The authorities did not allow selling and they would seize the birds.”

This team of district veterinarian and health worker asks the lady vendor where she slaughters her chicken. Birds are already dressed when brought to the market. The team asks her, “How do you slaughter chicken? How do you protect yourself when you slaughter the birds?”

One participant (at left side of photo), an epidemiologist of another team, talks to a lady vendor at the main bus station in Pakse. In the scenario, there was a suspected case of avian influenza virus that caused the culling of 300 chickens in one district. The epidemiologist asks the lady vendor if she notices people getting sick of influenza-like illness in her neighborhood. She also asks if the vendor has heard of people going to Ubon Provincial Hospital to get treatment of influenza-like illness.

This team held an interview with a lady vendor of rice and live chickens. The team asks her, “Where do you get your live birds? Do you raise them yourself? “If you raise chickens at home, how do you raise them? How do you keep your birds healthy and avoid bird flu virus?


This team asks a mother how much she knows about dengue fever. The doctor from Thailand asks the mother, “Are you aware that dengue fever was serious in this area four years ago? The most affected ones were children. How do you protect your family from getting infected? ” The mother replies, “yes, I am aware. The health care center of Xay Puthong district sends health staff to advise people on prevention of dengue in the villages, like clearing the bushes around residential areas and destroying the mosquito breeding places. My family sleeps under a treated bed net.”

This pair did more practice and demonstrated appropriate body language.

After the field exercise, following a structured script before, during, and after outbreak, the participants in pairs did more practice on “what to say” and “how to say” it effectively.

Theparticipantsdocumentedtheconversationduringthefieldexercise.Whenbackatthetrainingroom,theysharedtheirnotesandanalyzedtheirperformance.

AseniormedicalstaffmemberfromUbonRachataniacknowledgedthesignificanceofherlearningsduringthetraining.Shesaid,“Asamemberofoursurveillanceteam,Iamalwayspreoccupiedontellingpeoplewhattodo.Italktopeopleasanauthorityofthedisease.ThistrainingmademeunderstoodthatthereisonemoreimportantaspectIignored–andthatislistening.Listeningtothoseaffectedisbasictoaneffectiveoutbreakcommunicationandasimportantasprovidinginformation.Throughlisteningasoutbreakmanagerswewouldlearnhowaffectedcitizensunderstandandarereactingtoadiseaseoutbreak,theirperceptions,andleveloftrustandconfidencetoauthoritieslikeus.”

Hearingthetestimonialofthisparticipant,itwascleartomethatamongthefourcross-borderprovinces,thedynamicprocessofanoutbreakcommunicationcapacityhasevolved.Itneedstobesustainedthroughexercises,reviews,andupdatestoensureeffectiveness.


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MEKONG INFECTIOUS DISEASE BEHAVIOR CHANGE COMMUNICATION ...€¦ · This publication was prepared by The Mekong Infectious Disease Behavior Change and Communication Project, managed