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ZONE III SEHINAR ON ENVIRONMENTAL SANITATION

Sponsored by the

VllRLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC

Port Moresby

Terri tory of Papua and New Guinea

5 - 23 MB¥ 1958

FINAL REroRT

World Health Organization

Western Pacific Regional Office

Manila, Fhilippines

MB¥, 1960

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CONTENTS --------

INTRODUCTION • • • • • • • ,. ,. • • • • • • • • • • • • • 1

mE-5EMINAR INDIVIDUAL INTEREST QUESTIONNAIRE • • • • • • • •

mE-SEMINAR VISITS BY SEMINAR CONSULTANT • • • • • • • • • • •

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SEMINAR ORGANIZATION • • • • • • • • • • • • • • • • • • ••

TECHNICAL INFORMATION moGRAMME • • • • • · . .. .. .. .. • •

SEMmAR GROUP DISCUSSION moGRAMME • .. .. .. .. . • • • •• II

CONCLUSIONS REACHED BY THE SEMINAR GROUP • • •

EVALUATION OF THE SEMINAR GROUP DISCUSSIONS

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CONCLUSIONS .. ... .. .. .. .. ..... .. ..... .. .. .. .. .. .. . .. .. .. ... 19

10. APPENDICES

APPENDIX A - SEHINAR PRCXHlA.H)!E

APPENDIX B - PROJRAIIBE OF FlEW TRIPS

APPENDIX C - LIST OF PARTICIPANTS, OBSERVERS AND EEMBERS OF THE SECRETil.RIAT

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1. INTRODUCTION

The Zone III Seminar held at Port Moresby was the third in a series of ''lHO-sponsored seminars dealing with various aspects of Enviromnental Sanitation.

Because of the divergent public health pl'oblems of the several countries and territories that make up Zone ITI, the progrlllllllle was planned to cover those subjects in the field of envirol1l1lental sanitation of interest to the participants. The following countries and territories were invited to send participants: Cook Islands, Fiji, French Po:Q>neBia, Gilbert and Ellice Islands, Guam, ,jest New Guinea, New Caledonia, New Hebrides, New Zealand, Territory of Papua and New Guinea, The Kingdom of Tonga and viestsrn Samoa.

The general objectives of the Seminar were stated in a WHO conmmica­tion to participating governments on 30 July 1957 as follows:

1. To exchange information among participlting governments and territories as to the p1'esent status of enviromental sanitation.

2. To present through the media of lectures, liOl'king papers, demonstrations, group discussions and field trips, recent advances in the field of environmental sanitation of rural areas and villages.

3. To explore the possibility of more wide-spread and effective co-operation between countries with respect to common pl'oblems of environ­mental sanitation and better utilization of assistance by WHO to Member Governments.

It was further proposed that pending the suggestions of subject matter proposed by the participating countries and the evaluation of other environmental sanitation problems by the seminar consultant on the basiB of observations made during a pre-seminar visit to certain member countries of Zone III; the following would be included in the seminar pl'ogX'lllllll6:

"(1) disease patterns in relation to enviromental sanitation;

(2) present status of enviromental sanitation in countries and territories of Zone nI;

0) modern methods and recent advances in sanitation of rural areas and small. communi ties:

(a) water supply, (b) excreta disposal, (c) refuse disposal and utilization, (d) rodent and inBect control;

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(4) aclninistration costs and financing of rural and village sanita­tion facilities;

(5) operational and maintenance procedures for rural and village sanitation facilities;

(6) cOlIIl'lnmity participation in :ill1provelllent of environmental sanitation."

The suggestions received in response to a pre-seminar individual interest questionnaire and the observations made by the seminar consultant during his pre-seminar visit clarified SOllie of the problems to be discussed, but did not greatly change the proposed seminar objectives. The seminar participants represented a wide range of public-health interest - with an anticipated divergence of personal interest in the Subject matter of the seminar. The variation in interests on the part of the partiCipants and observers was evidenced by the following classifications:

Fhysicians - 5 Medical Practitioners - 7 Health Inspectors - 6 Asst. Health Inspectors - 3 Sanitarian - 1 Engineers 3

The staff consisted of four public-health engineers and a secretary, raising the total engineer group to seven (including two engineers with GoverIllllental Departments of Public Horks).

This variation in public-health interests was encouraged by WHO in its memorandum to Zone III countries which requested nominations to the seminar from the following groups:

1. Public-health administrators directly responsible for the planning or supervision of environmental sanitation programmes. (Note: of the five physicians attending, four were directly responsible under this category - and one was a teacher in this field.

2. Assistant medical practitioners (A.M. P.) who have responsibili­ties with respect to environmental sanitation. (Note: All A.M. p. s had an interest in environmental sanitation and were either alrea~ active or anticipated future responsibility in this field.)

3. Sanitary or health inspectors of the goverIllllental health service. (Note: All assistants and senior health inspectors, sanitarians and sanitary engineers included here.)

4. Technician of publiC works departments. (Note: Public works departments were represented by two qualified civil engineers with a real interest in and responsibility for the design, construction and operation of public works of sanitary interest.)

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2. ffiE-SElIJINAR INDIV:roUAL INT&I.E3T QtrdlTIONNAlRE

In order to determine the individual interests and environmental sanitation problens of the participants, each was asked to answer certain questions:

Question No.1 - requested information regarding the duties and responsibilities of the partiCipant. The answers reflected the variations that might be anticipated on the basis of the individual's professional or public health classification.

Question No.2 - requested information with regard to the main health problems in the individual's area. The following health problems were mentioned the number of times indicated:

Infectious hepatitis Leprosy Typhoid Malaria Yaws Malnutrition

- 1 - 1 - 1 - 2 - 2 - 3

Gastro-enteritis Ascariasis Filariasis Hookwol'lll Tuberculosis

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Question No. 3 asked '~ihich are the chief problems of hygiene and general sanitation in youc.' area?". The prinCipal problems mentioned were: water supply and waste disposal in rural areas, poor housing, mosquito and fl;r control, rat control, and sanitation of food handlers (one only). There was frequent mention of problems due to - lack of appreciation of the need for public-health - lack of understanding - ignorance of principles of sanitation - all evidencing 3n educational need.

Question Ro. 4 asked '~Jhich types of sanitary activities do you oarry out or supervise as a part of your job?"

AnSlolers to this question indicated activities as i'ollows: building and general sanitary inspections, mosquito, fl;r and insect control activity, participation in various campaigns - ym,s etc. - refuse disposal and educational activities. One questionnaire mentioned food and water inspectors. Aside from the general term "sanitation problems" only one mentioned activities with regard to :improved eJroreta disposal. However, some of the questionnaire returns were not complete.

Question No. S requested information with regard to "the main things you wish to learn at this seminar." Answers included the following comments:

(1) selling modern sanitation on "convenience basis";

(2) techniques of builcling construction, housing materials, town planning, hygiene of housing, insect and mosquito control;

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(3) techniques of protection of water and food sources;

(4) methods of educating reople in the need for sanitation and successful educational methods;

(5) expected in

practical tropical environmental sanitation and results to be the economic as well as the medical sphere and costs;

(6) administration of sanitation programmes in primitive cultures;

(7) to establish a rermanent friendlY relationship among partici­pants and island groups in relation to health and sanitation.

Question No.6 requested information with regard to ''l-Jhat purely technical information do you hope to obtain at this seminar?" This request brought well defined responses from which the following subjects are listed:

(1) Water supply

Well drilling - drive point wells on small islands surrounded by salt water - types of hand pumps - use of plastic distribution pipe. Use of the membrane filter for field bacteriological tests of water quality - types of hypo-chlorinators - the collection of food and water samples - small scale water supp~ and purification systems - testing of chlorinated water supplies.

(2) Sewerage

Design of waste disposal systems - beach latrine design - bored hole latrines - practical and economical methods of sewage disposal for rural areas.

t~) Housing

How local building techniques and customs can be adapted to good sanitary standards - details of low cost housing.

(4) Health education

Collection of material concerning customs, beliefs, etc. and its use in education. Methods useable by staff of low general training, training of health inspectors - visual aids.

(5) Insect control

Residual insecticides resisting heavy rain - recent or new methods of mosquito and f~ control - D.D.T. resistance.

Question No.7 requested a listing of those beliefs, supersti-tions and customs of the people in your area which you consider to inter­fere with your hygiene and sanitation programme.

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Many local customs and beliefs were listed. The following are typical observations:

(1) "Certain diseases are caused by spirits of the dead and are cured by herbal or magic treatment by non-trained bush doctors."

(2) Concealed practice of "sorcery".

(3) The belief that all illnesses are from the will or power of God, from Him the cure or death.

(4) Traditional prejudices against the discussion or disposal of bocV wastes.

(5) Certain cultures are barely approachable in the public health sense owing to distrust and village "tabu" customs.

(6) Keeping out devils by closing doors and preventing the entrance of fresh air. Resistnnce to European culture.

Question No.8 asked "I,lhat health education activities have you used in connection with your sanitary and hygiene work?" The following direct quotes indicate the scope of educational activities:

A. "Instructions were always given during a course of routine inspection on the danger of living in insanitary dwellings, living in dirty condition or overcrowded rooms, drinking contaminated wo.ter as well as the danger of living in a place heavily infested by insect vectors such as flies, cockroaches and other vermins. At the same time instructions for the abatement of such nuisnnces are given as well as the measures for the control of inoect vectors which are transmitting agents of many diseases."

B. "One of the main features of my job is that of continually trying to educate the local people in the importance of good hOUSing, sanitary facilities and water supply. This is done entirely by personal contact and by comparing those dwellings where we have obtained improvements with those where we have not. It is only by personal contact that ~ of these people can be roached as they frequently live some distance from main roads."

C. "For training of sanitarimls mld sanitariml-aids film strips made by the U.S.P.H.S. have been requested from a charitable Institute in the Netherlmlds that is interested in promoting health in the tropics."

D. "Possibilities here have been most limited by lack of trained personnel and by absence of co-ordination between mission mld other wrkers. Little has been done except where a Missionary or (more recently) an AMP, has actually been in residence for some years. Thus, it is true to sQY that only precept nnd example by "residents" has been used as a method of health education. "

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E. "While in the pcediatric services, mothers accompany babies when admitted. Mothers are taught the sanitary measures of living as well as the proper care of the babies."

F. "Group discussion at village and district level. Filmstrips with lectures. Radio talks."

G. COmmittees, area, IF

"Radio health talk. Health talk in village schools, in Women's in meetings with the chiefs and orators of the villages in the

3. mE-SEMINAR VISITS BY SEHINAR CONSULTANT

The report of tho pre-seminar visits to island groups ~ the con­sultant provides background information with regard to the environmental sanitation problems of some of th8 island areas represented at the seminar. During the Visits, an effort was made to understand and appreciate the many special problems that confront those who work in the field of public health under the varying conditions that exist in these island groups - and the administrative problems of those who have governmental responsibilit.1.

Supplemental to the individual reports made on these Visits, the following general observations are made:

Governments in countries which include large indigenous population groups, which have until recently lived in relative isolation from influences outside their village or tribal groups, are confronted with the delicate task of adding, to a social pcttern that has served to maintain the traditional wny of life, concepts of governmental responsibility necessary for the orderly procedures in a changing world. The former tribal group must become a more or less integrated group in a previously non-existent overall government. Its freedom to take independent tribal action is restricted by the basic rules of a societ.1 that is alien to their former way of life and regulation and restriction may be the first impact of this new and outside influence.

The amount of regulatory control required is dependant on at least two factors, first, the degrce of contact between the tribal or traditional pattern and the changing social pcttern - and second, the responsiveness of tribal leadership to the acceptance of changed concepts of social responsibility - and, through an underskmding of what these changes mean and What they require - to accept them with a sen so of citizenship responsibility.

One may observe that tho generGl responsibility of a government is to provide a social environment conducive to the growth, dovelopnent and well-being of those who live under its administrative authorit.1. Its policies should be such as to stimulate the greatest personal developnent and responsibility of each individual citizen and at the same time establish

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by law and rules that govern social and business relationships between citizens, to the end thnt the rights extended to one citizen shall not restrict or impinge on the rights of others.

A high standard of citizenship education is essential for the func­tioning of a governmental society that gives to· its people a high level of citizenship responsibility. However, it is possible for persons with little or no formal education to grasp the basic concepts of citizenship responsibility - and to make real contributions toward the advancement of the social group of which they are a part.

This leads to the observation that basic educational programmes may well be directed toward the objectives of giving to tribal group leadership. the type of instruction that will make it possible for the group to strive. develop and adjust to a new way of life.

Because good physical health is a basic need in any population group it follows that an early educational need for mry indigenous people is to learn how to maintain and improve their physical health to meet the demands and hazard of a changing environment.

The successful acceptance of the prinCiples of environmental sani­tation by a people who lack the background of the slow evolutionary changes that association with a knowledge of scientific research has brought to the peoples in other parts of the world - requires educational skills of the highest order on the part of those who stimulate Change and the patience to progress only as fast as comprehension of need is evidenced by the population concerned.

Environmental sanitation is a wB¥ of conununity life and its acceptance requires conununi ty interest and support. There are many wa:ys to arouse conununity interest in improved sanitation, but success will depend on an appreciation of the fact that community interest can exist only as the combined impact of interested individuals. A conununity does not become interested or informed except through the interest of the individuals who arc its members.

Consequently, there must be created in each individual, a desire for the benefits that good sanitation can provide and a willingness to work and to achieve these benefits before environmental sanitation concepts become an integral part of the cultural pattern of any group or village.

Because of the importcnce of leading people into the acceptance of the benefits to public health that can come only through their understanding of sanitation objectives - and tho belief that sanitation through regulation represents an emergency approach to the problem to be exercised only to meet emergency situations - the programme of tho seminar was developed with strong emphasis on the why of sanitation and how its principles might be taught to indigenous peoples as a way of life - rather than as a requirement of government.

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4. SEMINAR ORGANIZATION

The seminar as orgunized had two objectives: first, to provide sound technical information with regard to the solution of the sanitation problems confronting public-health rersonnel in the South Pacific area and second, to provide opportunity for group discussion of seminar selected topiCS of interest to the participants. (See programme attached as Appendix Aj

The technical instruction ,lUS given in both lecture and discussion group forms, supplemented Qy technical film strips and motion pictures. Most of the visual education material was obtained from the United States Public Health Service (USHIS) Communicable Disease Centro. 1fuile tho motion pictures and film strips were excellent in their presentation of subject matter, they were prepared for another environment and climate and were not as effective as films produced with a background of South Pacific environment would have been. Considerable interest was expressed Qy participants in the possibility of obtaining visual aid material suitable for village educational programmes.

The considerable variation in the academic preparation and public­health interests of the participant group made technical subject discussion periods an important part of this phase of the instruction. By dividing the seminar group into three sectiOns, an attempt was made to stimulate a maximum of individual participation in the discussion of the current technical subjects. There was some evidence that due to limitations in the total length of the seminar, the technical subject matter was covered too quickly and that there was not sufficient time for the seminar particiJ:aIlts to comprehend its significance.

Because of climatic conditions and the mid-day heat, the seminar hours were 0700-1200 hours and 1500-1700 hours, the morning hours being devoted to technical lectures, visual aid presentations, laboratory demonstrations and technical subject discussions periods. The afternoon periods were devoted to non-technical subjects such as health education. Three afternoon inspection trips and one all-d~ Saturday inspection trip provided both visual education and relaxation to the seminar programme. (Sec attachod Field Trip Schedule, Appendix B.)

5. TECHNICAL INFORMATION ffiOGRAMME

A total of approximatoly 64 hours were devoted to the technical information part of the seminar. Twenty-eight technical lectures were given on the following subjects:

PrinCiples of sanitation Basic measurements Ground water

5 lectures 3 lectures 4 lectures

Surface water Village latrines

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Septic tank _ tile field installations

Refuse collection & disposal Rodent control Insect control Housing

- 2 lectures 3 lectures

- 4 lectures - 2 lectures - 2 lectures - 1 lecture

2 lectures

28 lectures

Five lectures were given under the heading "Basic Sanitation" cover­ing the follOwing subjects:

(1) communicable disease - theories, ancient and modern;

(2) principles of bacteriology - classification, laboratory identification, biological reactions produced by growth;

(3) micro-organisms other than bacteria of interest as the causative agents of communicable disease;

(4) water quali~ standards - bacteriological, phySical, chemical standards of the United States Public Health Service, England, Germany and SwitZerland;

(5) biology of sewage treatment - primary annerobic action and secondar,r aerobic oxidation. Biological principles observed in sewage treatment plant design.

Three lectures were given under the heading "Basic Measurements" covering the following subject matter:

(1) basic units of volume measurement and conversion factors;

(2) volume, pressure and friction, loss in flow of water through pipes - water use and sterage requirements;

(3) concrete making and the use of levels and establishment of grades.

These lectures provided the limited knowledge necessary to a com­prehension of subsequent lectures involving design computations.

Films wore presented on tho following subjects:

(1) biology of domestic flies; (2) the problem of hookworm infection; (3) well-drilling hy the percussion method;

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(4) appraising soils for sewage disposal fields;

(5) constructing a typical household sewage system;

(6) pole drainage;

(7) sanitary storage and collection of refuse;

(8) refuse disposal by snnitary land fill;

(9) rural rat control;

(10) sanitation techniaues in rat control;

(11) the roof rat and Norway rat;

(12) rat proofing;

(13) fly control through basic sanitation.

The following fiJmst~ with accom]?ClJJYing recorded lectures were presented;

(1) introduction to bacteriology;

(2) basic use of levels;

. (3) introduction to insects;

(4) arthropods of public health importance;

(li) sampling and tGsting drinking water;

(6) sanitary IJSpects of tho drilled well;

(7) sanitary e.spects of the dug well;

(8) water filtration plnnts;

(9) trickling filter sew3gG treatment;

(10) permnnent ditch lining;

(11) recognitions of domostic rat signs;

(12) tho use of warfarin in rodent control.

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Laboratory demonstrations under the direction of Hr. Austin covered the following:

bacteriolor.r.i.cal examination of water by conventional methods; (Presented by Dr. Price of the Port Moresby Hospital Laboratory with his laboratory equipnent);

(2) demonstration of membrane filter techniques;

0) demonstration of measurements of salinity;

(4) demonstration of coagulations and chlorine residual measurements;

(5) laboratory exercise for the seminar participants in:

membrane filter tcchniques salinity measurements chlorine residual measurom~~ts

6. SEI1INAR GROUP DISCUSSION HlOGRPJ1ME

ApproximatelY twenty-four hours were devoted to group and plen~ session discussion of four topics selected by the seminar participants and observers from a group-suggested list of ten topiCS. The topics selected were:

1. Adapting environmental sanitation programme to existing cultural patterns and obtaining village co-op0ration and support for environmental sanitation activities.

2. Education, legislation and regulation as a means for securing good sanitation, including tho planning and implementation of a health education programme and the establishment of proper legislation to support an environmental sanitation progrcmne.

3. The responsibility and roles of administrators and public­health personnel in planning and carrying out an environmental sanitation programme.

4. The training of environmental sanitation personnel at various levelS for the South Pacific Islands.

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These topics were first discussed simultaneously in three groups _ each group formulating its independent analysis and reporting on the topic at the end of a furee~ar period. Subsequently, these three reports were discussed in plenary session, after which a general statement on each topic was prepared.

The statement and selection of Group discussion subjects by seminar group action were important in that they provided an opportunity for needed group participation. However, this did result in the selection of topics that were too broad in scope for the allowed two-hour discussion period and in some instances, in some divergence of ideas With regard to how a broadly­stated topic was to be considered. The interest and group participation in this part of the programme was excellent and the lively discussions that took place generated an exchange of ideas and viewpoints that should be of lasting value to the participants. Varied approaches to similar problems were noted and compared.

It appeared that the group made a real effort to appraise the need for better environmental sanitation in the South Pacific and to identify some of the factors that have retarded progress in this field of public health. The environmental sanitation needs were clearly recognized and the importance of having well organized educational and demonstration programmes to guide people into the observance of good sanitation ';as emphasized.

7. CONCLUSIONS REACHED BY THE SEMINAR GROU P

Topic I - Adapting environmental sanitation programmes to existing cultural patterns and obtaining villuge co-operation and support for environmental sanitation activities.

The seminar groups were in general agreement that village co-cperation and support for environmental sanitation progrmnme required that there be a cultural acceptance of modern concepts of communicable disease causation and a clear understanding of the cause-and-effect relationship between good sanitation and freedom from certain diseases. It was felt that changes would have to take plnee in the traditional concepts of disease causation which are a part of the old cultural pattern bofore modern concepts could be accepted and active rather than passive ce-operation obtained.

Mruv examples were cited to show that the current beliefs of some people would make it difficult fer them to accept environmental changes needed in the interest of good sanitation. For example, the belief that disease is caused by sorcery or by spirits Will lead te efforts to provide protection by metheds that have no relationship to the requirements of an improved environment.

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The statement that "old beliefs are not forgotten until new ideas are introduced and accepted" well expressed the seminar belief that envi­ronmental sanitation progrnromes required the gaining of the confidence of the people as a first step and that eXisting cultural concepts should not be disturbed until education has peved the way for the acceptance of a new concept.

The thought was expressed that because the cure of disease was a prime felt need, that the satisfying of this need was an excellent w~ to secure the interest and later the understanding neceGsary for the acceptance of new ideas with regard te the cause ef disease, and a recognition of the preventive value of environmental sanitation.

It was suggested that to be effective, the sanitarian Should have a genuine respect for another's culture and that he should be trained in the principles of interviewing teclmique and group qynwnics so thnt he might acquire a knowledge of the people's social structure, beliefs and attitudes.

A determination of the system of cultural values was regarded as important, for this could simplify the search for motivational forces with­in a culture, e.g., a high value placod upon the health of children could lead to acceptance of an environmental sanitation programme directed through the infant welfm'e centre, or azry spirit of competition among the women would be directed toward their competitlg as regards cleanliness, etc.

There was some thought that through an understanding of the meaning of the traditional taboos, sanitarians might avoid direct conflict with the past and plan improvements that could be accepted at least on a "convenience" basis. For example, duo to the belief in many areas that if same persons can obtain a portion of the feces,skin or hair of another, he is then able to cast a spell on the person concerned. It appears that this fear ~ be one reason why in some localities individual latrines ore not favoured and why perhaps water-borne s~~age or communal latrines might be acceptable.

It wes also observed that it was of great importance in initiating an environmental sanitation programme to understand the basis of authority and spheres of influence within a particular culture. For example, in one place the women of a village were instrumental in providing a flush toilet installation, the general opinion being that this ootivity was within the scope of the women's committee work, although authority concerning custom and law was vested in the male chiefs. It was suggested that existing beliefs should be slowly replaced with full recognition of the necessi~ for a changing of viewpoint on the part of those who hold positions of leadership. For example, tho witeh doctor maybe encouraged, as he plays his traditional role, to accept some of the modern ideas of medicine and sanitation as being useful to him. In other words, tho transformation of the beliefs of an indigenous people is a slow process and requires sympathetic understanding on the part of those who would introduce changes.

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Finally, it was suggested that it was most important in attempting to produce action in environmental sanitation to seek out the system of authority Within the culture and secure the co-operation of leaders who might have responsibility or special interest in better sanitation, with­out detracting in any waY from tho authOrity of othor leaders whose sphere of influence might lie outside tho demands of the environmental sanitation programme.

TopiC II Education, legislation and regulation as a moans for securing good sanitation, including tho phnning and implementation of a health education programme and tho establishment of proper legislation to support an environmental sanitation programme.

Discussions on this topic centred around the question of whether an environmental sanitation programme based on forced compliance with regula­tions was ever successful. It was the opinion of the group that forced compliance with regulation might be necessary in an emergency situation, but that regulation without an accompanying educational acceptance of the need for regulation was a negative approach l;ith little chance for permanent success in a democratic SOCiety.

The general conclusion was that "enforcement of regulations is the easy w~; persuasion, education and acceptance is the hard way", and that prosecution should be the last resort of the health officer and many pro­secutions are evidence of failure to educate within a SOCiety. It was further stated '!hat programmes based on the strict compliance with "the letter of the law" threats of punishment and a "policeman's attitudo" seemed certain to fail for such an approach creates resentment and resistance on the part of community groups.

It was considered that an educational programme should precede a law enforcement programme in order to ensure the support of the public who may be expected to demand certain regulations for their safety when once they understand the protective value of the regulations.

Persuasion and education which explains the meaning and reason for the regulations was regarded as a productive approach. The discussion developed the concept that the personality of the environmental sanitation worker was one of the greatest influenccs in ensuring compliance with necessary regulations and it >Tas felt by some that any training progrmnme for these workers should include studies of the basic psychological mechanisms underlying human behaviour.

The process of health education was consid~red and it was concluded that every he~lth worker is or should be a hcalth educator and that the best health educators are those whose work takes them into the homes of people to demonstrate their skills concerning health. Teachers, nurses, midwives, doctors, etc. were mentioned as persons who can help advance an understanding of the need for onvironmental sanitation.

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It was generally agreed that people in the top administrative posi­tions need education in sanitation to enable the drafting of necessary legislation and budgetary support. Any sanitary progrwane involving regulation and education should keep in mind the following:

(1) the social and technical development of the community;

(2) the economy of the community - can they afford it?

(3) the availability of social groups amenable to oducational methods, e.g., school childron, teachers, organizations, groups of mothers, etc.

(4) the training of oducators and/or inspectors to implement the programme with pc.rticulcr reference to training indigenous personnel to maintain responsible supervision for sanitation.

It was agreed that comprehensive legislation was indispensable to good sanita­tion and that under proper legislation, the necessOX"J regulations might be made to suit specific areas end problems.

The group noted a positive correlation between improved environmental sanitation and higher oconomic status but admitted that at present, not enough is known concerning the mechanisms involved in getting a people to continue an environmental sanitation progrnmmc M a part of their life after the original stimulus has been withdrawn.

Topic III The responsibility and roles of administrators and public­health personnel in pl~g and carrying out an environmental sanitation programme.

It was generally agreed that the public-health authority has the responsibility for promoting, preserving and maintaining the health of all the people within the existing economic possibilities. Also, that the ad­ministration of a country or territory should, in its poliCY, take into consideration tho economic, social nnd cultural factors nnd its planning should be guided by the advice from its public-hoalth agency in matters pertaining to its field of interest. Administrators of governments through­out the South Pacific should have the advice of their health agencies as to what is essential for providing an adequate stnndard of environmental snnita­tion. yet programmes should be flexible enough to meet the special problems of particular localities.

While recognizing that public works agencies havo the responsibility of planning in collaboration with other departments, and constructing necessary public facilities, the group was very emph~tic concerning the nllocation, outside the health dep~~tment, of responsibility as to the safety of utilities of public health importance. It was felt th~t the public-health agency should be solely responsible for determlnqz the public-health safety of utility services and that it would be dnngerous to delegc.te this responsibility to other departments. To this end it wns felt that publiC health personnel hnve a largo responsibility to co-operate with other departments whoso activities impingu upon or may be useful in improving sanitation.

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Continuous evaluation of public health programmes was reg~ded as an essential resp>nsibility of all interested in public health for it is by means of evaluation that evidence can be produced with which to cenvincc administrators to adopt policies permitting progressive improvements in environmental sanitation. It was recognized, however, that it was some­times difficult to produce convincing facts and figures in relation to social and economic benefits accruing from improved environmental sanita­tion (because such progrnmrnes must be long-range in both planning and in effects produced).

The whole of the health agency should share the responsibility for showing the need for any widespread environmontal sanitation progrnmrne, the field officer through his reports, his superior officer for recognizing the relevant portions of such reports, and the health department administrators for establishing the necessity for such a progrcmme, based on the data received, for submission to the head of the Government.

vJhen a programme is approved, it becomes tho responsibility of the administrator of the health agency to implement tho programme which he should do through the field officer whose observations established the need - with departmental instructions and advice.

It was observed that any widcspread planning of public-health projects involving other governmental agencies as for excmple, public works, should be approved at the General Administrator's level before such a project is started.

The seminar group had some difficulty in defining the meaning of "responsibility" as distinguished from "role". It concluded that the health department had responsibility for promoting programmes needed for the promo. tion and protectiGn of health but that Administrators have the role of evaluating the priorities that should be given in establishing the social and economic need for public health activities in compotition with other budget-supported projects such as agricultural progrcmmes and road construc­tions. It was strongly emphasized that the several agencies of government are not separate entities but only parts of the whole administration and that they should direct their efforts tOHard implementing the plans of the whole administration in a spirit of co-oporation and co-ordination.

TopiC TV The training of environmental sanitation personnel at various levels for the South Pncific Islands.

In its stuqy of the training nGeded for environmental s~itation personnel for the South PacifiC Islcnds, the seminar group evidenced a con­siderable divergence of thought. One pertinent suggestion was that the more primitive the people are, the greater the need for a close combination of medical (curative) training IlIld environmental anni tation. It wns thought by some that sanitation activities lacked the prestige value of medical treat­ment, perhaps because the ground has not been prepared for sanitary advances. It was suggested that the training of sanitation workers should be such

-17

that they will merit suitable prestige and status =ng the people with whom they work. It was thought that the sanitarians on the job "needs some of the outlook of the missionary" to minimize frustration in attompting to accomplish their public health objective.

In training environmental sanitation personnel for tho area, it was considered that more attention should be given to the practical side of instruction. The acquisition of skill in the basic and simpler engineering techniques was regarded as of value.

A warning was expressed that some sanitary inspectors, espocially the young and inexperienced, may adopt a "police" attitude and that their training should emphasize that working in public health means working with peeple. Tho thought was expressed that a young trainee should always work with an older and more experienced sQIUtarian.

Some of the seminar members thought that health inspectors and sanitarians should have an apprenticeship training to give them some practical experience background before taking their theoretical training.

Because of the public health impertance of some of the publiC works projects, it was believed that it would bo advisable for public works agencies to have at least one engine<.lr with special training in sanitary engineering to advise on the functional design, construction and operation of water supplies, sewerage and sewage disposal, heusing, etc.

It was felt by the group that some emphcsis should be given to the training of assistant sanitation porsonnel to ~JOrk at the village level and that by selecting for this training, persons with some prominence or recog­nition in their community, it would be possible to roach a larger number of villages with an effective programme. Such porsons would work under the supervision and technical guidance of more highly qualified sanitation personnel.

It was sUGGested that in the future, more attention would need to be given te the training of persons who would be qualified to take responsi­bility for programmes in environmontal sanitation, but that so far this level of training had been given little consideration because few environmental sanitation programmes outside of mc1aria control aro in operation.

Finally, it was suggested that all sanitation personnel needed the technical stimulation of rofresher courses or seminars whore they might add to their basic knowledge in their field. Suitable literature was also mentioned as an important educational aid. Also that opportunities should oxist for all lower grado technical personnel, by tho provision of text books, refresher courses, corrospondence courses, and similar means to quali£y "on the job" for advancement to positions of greater responsibility.

18

An attempt was mc-do to define environmental seniktion end this was given as "all those environmental factors which affect manlo h8alth". The following activities which comprise "environmental sanitation" wero listed:

(1) (2) (3) (4) (5) (6) (7) ( 8) ( 9)

(10) (11) (12) ( 13) (14) (15) (16) (17)

water refuse insect and rodent control SGwc.go food sanitation ionizing rndiQtion health education and training industrial hygiono housinG end buildings transportation sanitation and qunrentinc SWimming pools and beaches emergency and disaster sanitation relief research and evaltk~tion town and village planning noise c.bt:!.temont homo safety personal hygiene

It was obvious thnt considerable training will be necossary for environmental sanitation personnel to be qunlified in all these areas and that for the present, only the more pressinG problems should be included.

8. h"VAIDATION OF TIm SEMINAR GROUP DISCUSSIONS

In General, the seminar group had well defined ideas with regard to the part that environmental health should play in an overall public-health programme. The medical group recognized the importance of environmental controls in the abatement of certain communicable diseases and the health inspection group were in general well informed vIi th regard to the nature of the environmental hazards that might exist. llhile educational guidance was strongly stressed as the most effective method to use to secure the acceptance of enVironmental change necessary for good sanitation, there was some evidence that the group as a whole lacked the design knowledge necessary for demonstration teaching of how to construct the facilities needed for good sanitation. There was agreement that design of major public works of sanitary interest should be the responsibility of competent sanitary engineers in public works departments and also a realization that workers in environ­mental sanitation needed to know how to design and supervise the construction of the simple facilities needed for [;Ood village sanitation. While the technical part of the seminar programme attempted to fill in a part of this educational gap, the feeling expressed by some that subject coverage was too rapid for good comprehension suggests some lack of preparation for technical instruction. In the group discussion of topic four, there was a recognition

- 19

of a need for training those who would be working in the field of mental control in the "basic and simpler engineGring techniques". ment that "inspectorial duties and legal knowledge do not produce supply" was a pertinent ob servation,

environ-The state­

a good water

It was noted '.:,;u::':, ~'c, A.M" P. s (Assistant Medical Practitioners) have by their competence, gained a great deal of p::estige and that health inspectors or sanitarians needed similar recognition and that "effort should be made to improve the status of the sanitarian or health inspector". One group observed that the "training of ;;ani+,ation personnel for the South Pacific is a matter which has been giyen little cO:lsidera-tion yet as few rural sanitation progranmes are in oj:eration". Also; that "sanitary engineers are very rare in the South Pa~ific, t,r,e salle is '~rue fer a ce.tegory of personnel that is needed for rural sn..'litation wo, .. k".

While the thought was expressed that the A.N. P. might be given additional training in the principles of preventive medicine and sanitation, some doubt was expressed with regard. to '0he amount of time that a 3uccessful A.M. P. would be willing to devote to the envi:cor.mental sanitation in competition with curative medicine.

There was general agreement that the acceptance of modern concepts of public health must of necessity follm; the acceptance of curative medicine and that the A.M.P. should know enoC6h about envj.ronmental sanitation to open the way for the sanitarian but, having opened the way, that others with special knowledge and skill in the co-ordinated field of enVironmental control for the protection of health shouJ.d be p!:'8pJ.recl to 1:.ssurne responsibility in 'the field of environmental sanitation.

It would appear that those se!"'ing in thc field of environmental health are quite dependant for their guidt:..llCG on established rules and regulations and that there is a certain 13('J, of contact uith professionally trained personnel in their field - a contac~ that has given the A.M,P., in his field, recognition and standing.. It ie' Slcggested that the problems of environmental sanitation do require in their 801u'0ion the availahility of personnel with essentially the same level of educationaJ. preparation as is now required for the A.M.P., but with the educational p~gr~e directed toward preparation in the sciences and Skills 'i;ha'~ are required in tho planning of environmental changes for better sanitation,

9. CONCLUSIONS

"While it was the general opinion of the participarlts that the Port Moresby Seminar was successful in accomplishing : ~s objectives, in the final analysis its true value wEI be determined by it" impe.ct on the agencies that will plan and direct the heaHh activities of member countries in the years ahead.

20

The seminar l:..'1.der'jook to evaluate the problems of environmental sanita­tion on an area basis, viewed from the standpoint of a typical cross-section of the public-health workers concerned ~dth this phase of public-health work within the area. It took note of the special problems that arise incident to the introduction of new concepts of env;~onmental control for the protection of health in cultural groups that lack the b2.sic background information needed for the acceptance of required changes on the basis of regulation, and recog­nized the great importance of education through demonstration of what good sanitation can bring to the people of the islands.

It examined the echlcational l'ec;uirements of a JXlrson qualified to give guidance to sanitation demons'Gration ?rograrnrnes and instruction to those who need a greater kno"iledge of tbe ben-.'fits that sanitation can bring, and noted that such persons r;Clen8u :!n edue:lticnal preparation for sanitation work that would include the tccbnical aspect,s of ~TOrk in this field and that such training should make the sanita::'ian the environmental health counterpart of the A.M. P. in the fiele>. of me~.sal care.

The seminar o~'fe:C'ed no S.Llplc sO:.utions for the many environmental sanitation problems of the South Pacific area but for a period of three weeks it afforded an oppor'~unity for an in:er-island exchange of ideas and viewpoints and for the formation of friend3b~ps that should make co-operation easier in the years ahead.

Finally, for a time it se!~d to centre the attention of public-health and governmental adminis:'rators on an important area of public-health activity that needs greater recognition and support.

-

,.

,.

Monda;v, 5 May

0920 0945 1145 1350 1400-1600 1715

1900

Tuesda;v, 6 Ma;y

0650 0700-0800 0800-0900 0900-1000

1000-1015 -1015-1145 1145 1330-l450 l450 1500-1700

Wednesda;v, 7 May

0650 0700-0800

0800-0900 0900-1000 1000-1015 1015-1145 ll45 H)O-1330 1330 1330-l430

l430 1500-1600 1600-1700

*

SEMJNAR FROGRAMME

Bus leaves Moresby Hotel Open:iJJg ceremonies at Red Cross Hall Leave for hotel Bus leaves hotel for Red Cross Hall Orientation lecture

APPENDIX "A"

Bus leaves Moresby Hotel for Administrator's reception Bus leaves for hotel

Bus from hotel to PUblic Service Institute Principles of sanitation (Professor Boyce) Basic measuroments (Dr. Tom) Films: Roof Rat

Norwa;)'" Rat Tea break Plenary session Bus to hotel Study period - hotel Bus leaves hotel for Red Cross Hall Group discussions - Topic No. 1

Bus leaves hotel for Public Service Institute Principles of sanitation ) Professor Introduction to bacteriolo~ (F.S.)* ) Boyce Basic measurements (Dr. Tom) Film: Biology of domestic flies Tea break Technical group discussion Bus to hotel Per diem pqvments at Moresby Hotel Bus leaves Moresby Hotel Visit to Kila Quarantine Station. Snake venon

milking demonstration Bus to Red Cross Hall Group discussions - Topic No. 1 Group discussions - Topic No. 2

F .S. - f:iJl!lstrip

Thursda.y, 8 Hay

0650 0700-0800 0800-0900

0900-1000

1000-1015 1015-1145 1145 1330-1700

Friday, 9 May

0650 0700 0700-0800 0800-0900 0900-1000

1000-1015 1015-1145 1145 1330-1450 1450 1500-1700

Saturda;r2 10 Mal

Sunday, 11 May

Monday, 12 May

0650 0700 0700-0800 0800-0900 0900-1000

1000-1015 1015-1145

1145

-

-

- 2 -

Bus from hotel to Public Service Institute Principles of sanitation (Professor Boyce) Basic measurements ) Dr Tom Basic use of levels (F .5.)) . Film: The Problem of Hookworm Infection

Introduction to the Insects (F.S.) Tea break Technical group discussion Bus to hotel Field Trip No. 1

Bus from hotel to Public Service Institute Reports of groups on TopiC No. 1 due Principles of sanitation (Professor Boyce) Ground water (Mr. h.ustin) Filmstrip: I.rthropods of Public-Health

Importance Tea break Technical group discussion Bus to hotel Stuqy period - hotel Bus from hotel to Red Cross Hall Group discussions - TopiC No. 2

F R E E

F R E E

Bus from hotel to Public Service Institute Reports of groups on Topic No. 2 due Principles of sanitation (I'rofessor Boyce) Ground water (Mr. Chayabongse) Film: Drilling by the Percussion Method F .5.: Sampling and Testing Drinking ~,vater

The Drilled ,Ie11 - Sanitary Aspects Tea break Demonstration: Bacteriological examination

of water (Dr. Price) Bus to hotel

..

--- 3 -

Mondgv, 12 May (cont' d)

1330-1450 1450 1500-1600 1600-1700

Tuesday, 13 Ma,y

0650 0700 0700-0800

0800-0900 0900-1000 1000-1015 1015-1145 1145 1330-1700

Hednesday, 14 Mgv

0650 0700-0800 0000-0900 0900-1000 1000-1015 1015-1145 1145 1350-1450 1450 1500-1700

Thursday, 15 Mgv

0650 0700-0800 0800-0900

0900-1000 1000-1015 1015-1145

1145 1350-1450 1450 1500-1700

1930

Study period-·- hotel Bus from hotel to Red Cross Hall Plenary session - Topio No. 1 Group discussions - Topic No. 3

Bus from hotel to Public Servioe Institute Plenary report on Topic No. 1 due Ground water ) Mr The dug well - Sanitary aspects (F.S.» • Village latrines (Mr. Chayabongse) Group technical discussions Tea break

Austin

Demonstration: Membrane filter techniques (Mr. Austin) Bus to hotel Field Trip No. 2

Bus from hotel to Public Service Institute Ground water (11r. Bierstein) Village latrines (11r. Chayabongse) Danonstration: Measurement of salinity (Mr. Austin) Tea break Technical group discussion Bus to hotel Study period - hotel Bus from hotel to Red Cross Hall Group discussions - Topic No. 3

Bus from hotel to Public Service Institute Village latrines (Mr. Chayabongse) Surfaco water ) Filtration plants (F.S.) ) Professor Boyce Group technical discussion Tea break Demonstration: Coagulation and chlorine

measurements (Mr. Austiri) Bus to hotel Study period - hotel Bus from hotel to Red Cross Hall Laboratory: l1embrane filter techniques Salinity measurements Chlorine measurements Dr. Gunther's party

Friday, 16 May

CX)50 0700 0700-0800 0800-0900 0900-1000

1000-1015 1015-1145 1145 1330-1700

Saturday, 17 Ma;y

All day

Sunday, 18 Ma,y

Monday, 19 Ma;y

CX)5o 0700-0800 0800-0900 0900-1000

1000-1015 10l5-1145 1145 1330-1450 1450 1500-1600 1600-1700

Tuesday, 20 May

CX)50 0700 0700-0800 0800-0900 0900-1000

1000-1015 1Dl5-1145 1145 1330-1450 1450 1500-1700

- 4 -

Bus from hotel to Public Service Institute Reports of groups on Topic No. 3 due Surface water (Professor Boree) Septic tanks (Mr. Bierstein) Film: Appraising Soils F.S.: Trickling Filter Plants Tea break Group technical discussion Bus to hotel Field Trip No. 3

Field Trip No. 4

F R E E

Bus from hotel to Public Service Institute Septic tanks (Mr. Bierstein) Housing (Dr. Lonie) Film: Constructing a typical household ~stem F.S.: Permanent ditch linings Tea break Group technical discussion Bus to hotel Stuqy period - hotel Bus from hotel to Red Cross Hall Plenary session - Topic No. 2 Group discussions - Topic No. 4

Bus from hotel to Public Service Institute Plenary report on Topic No. 2 due Septic tanks (Hr. Bierstein) Hoae1ng (Dr. Lonie) Films: Pole drainage

Individual sewage disposal systems Tea break Group technical discussion Bus to hotel Stuqy period - hotel Bus from hotel to Red Cross Hall Group discussions - Topic No. 4

Wednesday, 21 May

0650 0700 0700-0800 0800-0900 0900-1000

1000-1015 1015-1145 1145 1330-1450 1450 1500-1600 1600-1700

Thursday. 22 M8jV

0650 0700 0700-0800 0800-0900

0900-1000

1000-1015 1015-1145 1145 1330-1450 1450 1500-1600 1600-1700

FridaY, 23 May

0650 0700 0700-0800

0800-0900 0900-1000

1000-1015 1015-1145 1145 1330-1450 1450 1500-1600 1600-1700

- 5 -

Bus from hotel to Public Service Institute Reports of groups on Topic No. 4 due Septic tanks (Mr. Bierstein) Refuse collection and disposal (Dr. Tom) Films: Sanitary storage and collection of refuse

Refuse disposal by sanitary landfill Tea break Group technical discussion Bus to hotel Stuqy period - hotel Bus from hotel to Red Cross Hall Plenary session - Topic No. 3 Plenary session - Topics Nos. 1 and 2

Bus from hotel to Public Service Institute Plenary report on Topic No.. 3 due Refuse collection and disposal (Dr. Tom) Rodent control Recognition of domestic rodent signs (F.S.) Films: Rural rat control

Sanitation techniques in rat control Tea break Group technical discussions Bus to hotel Stuqy period - hotel Bus from hotel to Red Cross Hall Plenary session - Topic No. 4 Special Interest session

Bus from hotel to Public Service Institute Plenary report on Topic No. 4 due Rodent control The use of warfarin in rodent control (r .S.)

(Mr. Bierstein) Insect control (Professor Boyce) FilJlls: Fly control through basic sanitation

Rat proofing Tea break Group technical discussion Bus to hotel Stuqy period - hotel Bus from hotel to Red Cross Hall Plenary session - Topics Nos. 3 and 4 Final p1enaI"J session

~Mr. Bierstein

--

1330

AFP.c:NJ)IX "B"

rROGRAMl-1E OF FIELD TRHS

Field Trip No.1 Thursday, 8 May 1958

Bus leaves hotel to Koki market markot for floating population. meat and other foodstuffs.

(15 minutes) Visit public Sale of produce, fish, cooked

1430 Bus leaves Koki market for Kaugari village (20 minutes). Inspect settlement for government staff. Two-room houses of sta.'1dard design. One model home UGing soil, cement bricks under construction ~lic water system drawn from pontoon tanks by means of a

semi-rotary hand pump Excreta disposal by pail system Refuse collected from drums

15)) Bus leaves Kaugari village for Korobosea village (20 minutes) Inspect village of about 20 homes (constructed of corrugated

sheets) Public water system from two pontoon tanks with hand pump Pit privy using opon-ended oil drums for pit lining Refuse tippod into rubbish pit Rain-water collection also practised, using temporary gutters

to divert water into oil drums

1615 Bus leaves Korobosea village for hotel (20 minutes)

Field Trip No. 2 Tuesd<w, 13 May 1958

1330 Bus leaves hotel for Bomana (one hour)

1530

1615

Inspect water treatment plant and pump station Basic data: To be furnished later

Bus leaves water plant for G601 Gardens (15 minutes) Inspect SOil-cement, bric!{ making Production: 500 bricks/hand machine/ d<w Mixture 1 part cement to 10 parts soil (passed

through 1/4" screen) Production cost £'8/ -/ -/1000 bricks (.517.92/1000 bricks) Government hopes to encourage home construction with 60il­

cement bricks.

Bus leaves Gaol Gardens for hotel (1 hour, 15 minutes)

1330

- 2

Field Trip No.3 Friday, 16 May 1958

Bus leaveG hotel to Health Department. Hygiene store area at Konedobu (15 minutes)

Inspect models of septic latrine, incinerator, steam sterilizer and pit privy (for details see distributed drawing)

1415 Bus leaves Konedobu fcr Paga Foint (15 minutes) Inspect nightsoil receiving and disposal station Nightsoil collection. Three times per week per household

serviced. Collection service change £O.lO.B ($1.20) per household

per month. Collection by private collector under contract with Government. Nightsoil trucked to disposal station in six-gallon tar-coated

pails, emptied into receiving pit and discharged to sea through a short outfall pipe.

Salt water pumped to flush nightsoil receiving pit and to rinse pails.

Pails immersed in phenol solution, inverted over steam jets for two minutes and stacked to dry.

1500 Bus leaves Paga Point to Boroko (30 minutes) Inspect sewage treatment plant Basic data: To be furnished later

1630 Bus leaves Boroko to hotel (30 minutes)

Field Trip No.4 Saturday, 17 Nay 1958

0800 Bus leaves hotel to Bemona Har Cemetery (30 minutes) Visit i~ar Cemetery

0$00 -

1100

Bus leaves ~var Cemeterr to hydro-electric plant at Sogeri (1 hour, 10 minutes)

Visit hydro-electric plant and Rouna falls

Bus leaves Rouna to Koitaki sports ground (1 hour, 30 minutes) Picnic lunch at Koitaki (lunch provided from hotel and drinks

obtained from Koitaki club) V isi t rubber plant and labour lines

14)) Bus leaves Koitaki to hotel (3 hours)

,

- 3 -

Picnic at Tararoa Sundaj,y. II May 1958

0900 Bus leaves hotel to Tarama (1 hour)

1400

SwjJmning and lunch at Tarama (lunched provided by hotel and drinks to be brought along for sale to participants)

Bus leaves Tarama for hotel (1 hour)

"

APPENDn "c"

LIST OF PARTICIPANTS, OBSERVERS AND MEMBERS OF THE SECRETARIAT

I. Participants

1. Mr. Fa1ali1i fili)lJNA Medical Practitioner c/o Health Department Apia, "!estern Samoa

2. Mr. Peter BECK Assistant Medical Practitioner Central Hospital Honiara British Solomon Islands Protectorate

3. Dr. Klaas BIERSTEKER Government Pnysician Department of Health Hollandia Netherlands New Guinea

4. Dr. Robert K. BCWMAN British Medical Officer British Residena,r Vila, New Hebrides

5. Mr. F. Robert BUGG Chief Sanitary Inspector P. O. Box 17 Apia, Western Samoa

6. Mr. Ponipate Q. Cl.GI Assistant Health Inspector c/o Medical Department Suva, Fiji

7. Mr. Donald HERBORN Health Inspector

8.

c/o Department of Public Health Lae Territory of Papua and New Guinea

Mr. Sale IEREMIA Medical Practitioner c/o Health Department Apia, Western Samoa

9. Mr. Purshottam KRISHNAN Assistant Health Inspector c/o Medical Department Suva, Fiji

- 2

10. Dr. Jacques LJ,IGRET Director, Institut de Recherches medicales de la Polyn6sie fran~aise

Papeete, Tahiti

11. Mr. Francisco C. mON GUERRERO Sanitarian Sanitation Section Public Health Division Guam Memorial Hospital Agana, Guam

12. Mr. Peni M[,PA Assistant Medical Practitioner c/o l'Iedical Department Nuku1alofa, Tonga

13. Mr. S imeona lliNI Assistant }ledical Practitioner Central Colony Hospital Tarawa Island Gilbert and Ellice Islands Colony

14. Mr. Sadaraka SAMUELA Assistant Health Inspector Arorangi, Rarotonga, Cook Islands

15. Mr. Christopher J. SAUNDERS Senior Health Inspector Department of Public Health Port Moresby Territory of Papua and New Guinea

16. Dr. Godfrey C. SCOTT Lecturer in Preventive Medicine SchOOl of Public Health

and Tropical Medicine Univorsity of Sydney Sydney. N.S.H., l,ustralia

17 • Mr. Iltrk VI. T.'.RENSKEEN Chief Engineer Department of Public Works R. W. D., Hollandia Netherlands New Guinea

\ - 3 \ -,

18. Mr. Reuben TAlJREKA hssistant }!edical Practitioner Public Health Department KukiPi> C.D. Territorl of Papua and New Guinea

19. Mr. Fiafia TUAUA Mediual Practitioner c/o Medical Services Department Pago Pago American Sanaa

II. Observers

1. Mr. John AUSTIN Sanitary Engineer USOM H & S c/o lunerican Embassy Saigon, Vietnam

2. Mr. Ronald J. BmCH Health Inspector c/o P.H.D., Rabaul

3.

Territor,{ of Papua and New Guinea

Mr. p. M. HOdELL Health Inspector P .H.D., Madang. New GUinea

4. Mr. A. GRJ.COVICH Hydraulics Engineer Commonwealth Department of Works Port Moresby Territory of Papua and New Guinea

5. Dr. Thomns C. LONIE Public Health Officer South Pacific Commission Anse Vata, Noumea, New Caledonia

6. Dr. H. N. White Assistant Director of Health Box 194, Port Moresby Territory of Papua and New Guinea

7. Mr. R. S. WILLIS Health Inspector Box 19, Port Moresby Territory of Papua and New Guinea

- 4 -

. 3. Members of the Secretariat

1. Mr. Paul BIERSTEIN Director of Seminar 10/1:10 Regional Adviser on Environmental Sanitation l·mO/W::RO, P.O. Box 2932 Manila, Fhilippines

2. Professor Earnest BOyCE Technical Director of Seminar Professor, College of Engineering and School of Public Health University of Michigan 1601 Granger Avenue f~ Arbor, Michigan U. S. 1'...

3. Mr. Chamras CHAYABONGSE WHO Sanitary Engineer Environmental Sanitation Project in Vietnam Bureau de 1 r OMS Bone postale 242 Saigon, Vietnam

4. Dr. Albert Q.Y. TOM WHO Sanitary Engineer Environmental Sanitation Project in Taiwan Taiwan Institute of Environmental Sanitation 12 Foochow Road Taipei, Taiwan Republic of China

, , ,

,

I I . ,