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Is it Time to Rethink Bali's Response to H1N1?

Editorial: The Changing Character of the H1N1 Epidemic Will Compel New Tactics in Confronting the Disease.

(7/20/2009) Bali's transparency and aggressive steps to thwart the spread of "Swine Flu" or the H1N1 Virus are worthy of praise. From the earliest days of the most recent outbreak in Mexico - Bali, together with the rest of Indonesia, has tried to stem the spread of the disease by establishing screening procedures at international airports and providing free-of-charge medical care at special isolation wards in leading hospitals. Masks are also being issued and special medical containment teams deployed to help fight the plague. At the same time, money and talent are being expended to educate the public about the disease in an effort to prevent widespread panic and maintain normality in the lives of people living in Indonesia.

Change Ahead?

The changing face and character of the H1N1 epidemic, however, may dictate the need for a new response to this global health threat. The decision last week by the World Health Organization (WHO) to no longer publish or minutely track new cases H1N1 cases and the abrupt change from a trickle to a flood of new patients coming to Bali's Sanglah General Hospital every day for treatment, reflects the sad fact that the disease is spreading at an increasingly rapid pace. The Bali hospital's isolation ward is nearly filled to capacity, causing doctors to rightly wonder what they will do when, and no longer if, the number of new cases escalates further.

It now seems inevitable that Bali will be compelled to adopt a medical response resembling that taken by its near neighbor, Australia. In Australia, where confirmed cases of H1N1 now number in the thousands, people suffering from "Swine Flu" are not hospitalized but, instead, told to go home, rest, avoid human contact and take Tamiflu. Australian isolation wards are reserved for treating only those H1N1 cases in which life-threatening complications are also present.

That Indonesia may have to abandon its hospitalization and isolation policy will soon move beyond choice; the carrying capacity of isolation wards are being overwhelmed by new H1N1 cases.

New ways of dealing with this disease are urgently needed. The Country's medical experts must join forces with other sectors of society if Indonesia is to develop a coordinated and genuinely humane response to the changing face of H1N1.

Effective measures to limit the damage inflicted by this disease won't be easy. Creativity, generosity and transparency will form core themes in any intelligent "new" response to "Swine Flu." Those measures will have to contemplate how, in a country where poverty is a fact-of-life for many, to help people stay at home, take their medications and avoid human contact until the infectious period of around 7 days passes. Smart solutions may include means of delivering food and medications without charge to people who would otherwise be compelled to earn a living or make a daily trip to a local marketplace.

Bali, as a leading world tourism destination, will also have to determine how to deal with a tourist confirmed with H1N1. Will hotels in cooperation with the government offer free accommodation during the infectious period? Will each hotel need to set aside a separate wing to house these visitors? Will staff undergo special training and learn to use special equipment to protect themselves and others from contamination while serving ill guests? How will hotels and police deal with infected visitors who stubbornly refuse quarantine?

Clearly, there are tough choices ahead, And, H1N1, as with the remedy for any human tragedy, requires massive dosages of leadership, wise thinking and human compassion.