In the correspondence below we see that a WHO regional advisor writes "Myanmar has one of the BEST public health care delivery system in the world." This makes the [him] moderator concerned about the mental health of the advisor.

What is the evidence base that mental health interventions after emergencies are effective?

[him] moderator

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Dear all,

Our WHO Regional Advisor for mental health for Southeast Asia, Dr Vijay Chandra,  knows Myanmar quite well and has emailed the following information to me, which may be relevant. Please feel comfortable to contact Dr Chandra (chandrav@searo.who.int) directly if you have
 questions.

One of the next steps should be to learn more about the contents of the existing Burmese-language documents on post-emergency mental health developed for Myanmar (my understanding is that these do not exist in English translation). Please find his self-explanatory communications below.

Best wishes,

Mark

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Dear Mark [snip]

I know Myanmar very well and it has many positive aspects which can be very useful for mental health and psychosocial relief efforts. Some of the positive points are:

1.         They have many well trained and highly qualified mental health professionals. Two of them have already gone into the field and must be back. Thus there is virtually no role for any foreign psychiatrists.
2.         Myanmar has one of the BEST public health care delivery system in the world. It works very well and reaches out to each and every village. I have seen it myself and can testify to this. Of course, the system is severely damaged in the cyclone, but THE EXISTING system needs to be rebuilt.
3.         Myanmar has a very rich culture: deeply religious, respect for the elderly, children and the sick, lot of voluntary work and donations. All these positive aspects need to be mobilized for the benefit of psychosocial relief.
4.         There is a nation-wide NGO Myanmar Maternal and Child  Welfare Association (MMCWA) which exists in every village. This is officially recognized by the government and their volunteers do an excellent job in community services, dealing not only with women and children, but also social issues such as hygiene and sanitation in the village. They can be easily mobilized to provide psychosocial relief to the community after proper training.
5.         Experts from Myanmar have participated in the ¨[WHO] SEAR [Southeast Asia Region].  inter-country workshop on mental health and psychosocial aspects of disaster preparedness so are well aware of these aspects.
6.         Myanmar has held a national workshop on mental health and psychosocial aspects of disasters. They have translated and adapted many of the [WHO] SEARO documents developed during the tsunami.
7.         Within a few days of the disaster several technical  documents dealing with mental health and psychosocial relief (including [WHO]  SEAR [Southeast Asia Region].  documents and IASC documents) were dispatched to Myanmar, and given to the local experts.

 I completely agree with the activities listed in the Inter Agency Standing Committee uidelines. The main issue is how to implement these. In my opinion this MUST be done by local experts using local resources, and can be done in a variety of ways. These must be sustainable so the community can continue these after external agencies leave.
 Please note that all external agencies need to work WITH AND ENHANCE  THE EXISTING SYSTEMS OF MYANMAR, NOT TRY TO DEVELOP NEW ONES. This way, as  our experience in Bangladesh, India, Thailand and Maldives who used internal expertise (not foreigner experts), shows that it remains in  the country for ever. External experts have a limited advisory role.

[new message, received today]

Please feel free to share my message about the positive aspects of  Myanmar with anyone. There are many more positive aspects which will take a Long time to write about. However, a few additional points are:

1.      Myanmar Maternal and Child Welfare Association (MMCWA): As I wrote yesterday, this is a village based NGO which exists in almost every village. The administrative structure works its way up to a national headquarters in Yangoon. It is recognized by the government. The volunteers live in the village, are trained by the parent organization, interact with the community and village leaders. The community looks at them very favourably. These volunteers would be ideal to launch the psychosocial support after adequate training. Any agency can do the training (I am completely open to partnerships, in fact, for psychosocial relief we  must work with other agencies) as long as they train correctly and appropriately.

2      There is also a Myanmar Women’s Association based in each  village. They look after women’s issues including safety and micro-credit to start a business. They are also a vital village based resource.

3      The Myanmar people are extremely generous with donations of money and do volunteer work for no money. Doctors provide free care after office hours. Business men donate huge funds for social welfare. Also they are a very caring society, so it should not be difficult to ensure the  welfare of children (particularly orphans), women (also see above), elderly and
disabled people. Of course they can be supported in setting up child friendly places. I am told that all schools will reopen by June 1, and are being rebuilt through local business men.

4.      Myanmar has a range of health workers including GPs which make up a very effective primary health care system. Some of the health workers live in villages and are a direct link to GPs (usually government doctors and some in private practise). I have to see how much this system has been damaged and we can train them in mental health care.

5.      There are a large number of technical documents already  prepared by local experts which are of very good quality.  We need to see if they actually require any other documents or what they have is enough. We  have CD based and paper based manuals on training of GPs in basic mental  health care which have been very successfully used in ¨[WHO] SEAR [Southeast  Asia Region].

We need to act in Myanmar ASAP. The local resources although severely damaged are huge and very resilient. So I am very optimistic about what  can be done in Myanmar.

As I have said above, I fully support a partnership in the psychosocial relief efforts. In Bangladesh we found that bringing all interested agencies together was very fruitful. They commented on the manuals, sent their staff for training, marked out their area of interest and
 Operation and went to work. I am sure we can do this and maybe better in Myanmar.

Best wishes.

Sincerely:
Vijay

Dr. Vijay Chandra
Regional Advisor, Mental Health
WHO Regional Office for South-East Asia
New Delhi, 110002
INDIA
Phone: 91-11-23370804 (Ext. 26572 & 26532)
Fax: 91-11- 2370 5714 (Direct)
Email: chandrav@searo.who.int