This is Episode 23 of Contain This, brought to you by the Indo-Pacific Centre for Health Security and is hosted by Australia’s Ambassador for Regional Health Security, Dr Stephanie Williams.
In this installment of the Indo-Pacific Health Leaders Series, Stephanie speaks with Dr Bouaphanh Khamphaphongphane on the Lao response to COVID-19 response.
Dr Khamphaphongphane is the Deputy Director of the National Centre for Laboratory and Epidemiology in the Lao People's Democratic Republic. She is also a supervisor of the Laos Field Epidemiology Training program and the ASEAN-Australia Health Security Fellowship. During the early days of COVID-19 outbreak, she supervised rapid response teams in provinces to look for suspect cases and worked closely with WHO to conduct COVID-19 testing.
We hope you enjoy the episode.
For more information about the Indo-Pacific Centre for Health Security, visit our website https://indopacifichealthsecurity.dfat.gov.au.
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The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government.
Welcome to Contain This. I’m Dr Stephanie Williams, Australia’s Ambassador for Regional Health Security. Today I have the second interview in our Indo-Pacific Health Leaders series for this year.
I spoke to Dr Bouaphanh Khamphaphongphane last November.
She is the Deputy Director of the National Centre for Laboratory and Epidemiology in the Lao People’s Democratic Republic.
During the early days of COVID outbreak, she supervised rapid response teams in provinces to look for COVID suspect cases and worked closely with WHO to conduct COVID testing.
Dr Bouaphanh is a supervisor of the Laos Field Epidemiology Training Program (FETP) and the ASEAN-Australia Health Security Fellowship, which is funded by us here at the Indo-Pacific Centre for Health Security and will be the subject of an upcoming podcast episode.
Australia continues to support the National Centre for Laboratory and Epidemiology for COVID-19 response and has committed to assist the vaccine rollout in the coming year. But more about that in future episodes.
In this interview we talk about Lao’s response so far.
Dr Bouaphanh, welcome to Contain This.
In the early phases of the pandemic, as a technical leader and a health leader in Laos, I'm interested in how you addressed uncertainty about COVID-19 in the early phases.
Dr Bouaphanh Khamphaphongphane 04:03
I think for the uncertainty COVID-19, I just realized that the important thing for the uncertainties for any public health threat that may happen, then we have to keep an opening, an open mind, and also be honest about what we know and what we don't know. And try to share the experience and thinking about the network is really important how to use the access to the information that are available from the regions to be our key information in terms of the specifics or assessment of what is to be the next step of going on in order to prepare us to respond to the uncertainties.
Dr Stephanie Williams 04:57
Do you think... how did it go when you said we don't know? Sometimes I think in science, we find it easy, easier to accept what we know and what we don't know, it's a natural part of science. But when you were in the position of having to communicate what we didn't know, how did that work to your government or senior counterparts?
Dr Bouaphanh Khamphaphongphane 05:27
Well, accordingly I take the line to say what we don't know, and then how we can convince our leaders and governments aside, we may need to work on the available information and tell to the publics that this is what the information that we have. The suggestions may be changing, our position may be changing according to the information available. This is the key and concept or key idea that we try to convince the government or Laos leaders is how we can move forward with the uncertainty information or unclear information that we have at this moment. We have to be honest, because nowadays, our general public in Laos, they are really clever, they are catching up with the social media news. If the government don't take action properly, or more advanced than them, then give them the right information, then maybe it'll create another problem or panic in terms of the big government decision, and also how we can convince our people. We have to say that, to be honest, what we know and we don't know. And then based on the information, then we can provide later on when the correct information is available.
Dr Stephanie Williams 06:51
So a lot has changed since we were in that position in January, February, March having to brief daily or hourly. I'm sure you were very pushed for your time. Now, when we think it's November 2020 and you look back over the last few months, what are you most proud of in terms of the way you in your role or your teams have responded to the challenge of COVID-19 in Laos?
Dr Bouaphanh Khamphaphongphane 07:17
I think most of how did we created our strong network and foundation through the public health staff, that we tried to prepare and strengthen our capacity, that we strengthen our the field epidemiology training program that we are working on. That we used that workforce, to be our additional hand to help us to respond to any uncertainty or any public health event that may happen.
Dr Stephanie Williams 07:54
And can you tell us a bit more about the workforce? So Laos' population? How many FETPs [Field Epidemiology Training Program graduates did you have? And did you have to recruit more? I'm interested in how that network was able to be deployed.
Dr Bouaphanh Khamphaphongphane 08:12
Currently, we have nearly 100 graduates and we have 8 current trainees. Now that's cohort 12. We try to keep them in our loop or networks by creating the Action Program. Then we have the alumni workshop, twice a year, then we send out the invitation letters, providing, inviting them to be additional workforce or surge capacity for investigation. Also for contact tracing by providing them the online training because during the beginning of this year, people aren't going to travel particularly during lockdown period. Then they have to stay in their own province but we use the opportunity by using the online training to provide them the concept of how we conduct the investigation or contact tracing regarding the COVID-19 response. That is we provide some additional funding to them how to provide additional support besides the provincial financial budget. This one thing that we provide is the SOP to them, then follow up by calling their daily meeting, weekly meeting with them, that's the way how we can use them even if they are in the provinces that they have to assign some work to do. They also recent trainees, Cohort 12. They are the most important group that support my office to enter the data every day, like the full contact tracing that we have, nearly 400 close contacts that need to be input for that period. It's very challenging, without them we cannot assess it, in terms of the COVID response model.
Dr Stephanie Williams 10:18
So I don't think there's a single FETP graduate in the world that potentially wasn't drawn into the COVID response in their countries. Tell me about when Lao started the FETP. The 12th cohort was that 12 years ago or longer, and what led to the creation of this workforce?
Dr Bouaphanh Khamphaphongphane 10:39
We established the Laos FETP in 2009, which is the same as me, I'm the first cohort for that. I still remember that we were deployed to respond to the pandemic of H1N1, the first imported cases, that is almost 12 years ago now.
Dr Stephanie Williams 10:59
It's so often the case that the first cohort of an FETP become leaders like yourself in each country and it's terrific to see that ongoing alumni and strength of the network. I want to move now into the current challenges you see for Lao with response to COVID. I know there's been some cases, we can see this is clearly a medium to long term infectious disease event. How would you characterize some of the biggest challenges you are facing today?
Dr Bouaphanh Khamphaphongphane 11:35
The biggest challenge for any public health workforce is mostly regarding to the human resources, in terms of numbers because we have quite a small population in Laos but we also the small public health workforce. They have their own routine works that they have to complete and have to carry on more than 100 percent. Then now we have additional pandemics, which is before the pandemic of COVID-19 happening. Then we also facing for the measles outbreak is quite big outbreak in Laos at a time in the beginning of 2019 then carry on to the end of 2019. We are already exhausted with the responding to the measles outbreak in many provinces, 12 provinces that mean more than 80% of the total population is affected by measles outbreak at a time then followed by the COVID-19 at the beginning of this year. Now it's almost 11 or 10 months, that is quite prolonged pandemic period that we have seen. So another challenge is the pandemic fatigue that we have to participate in many challenges or handling challenges, like other countries. That is how we can be maintaining the momentum and awareness of public health workers and also the clinicians, nurses who are working in the health facilities with that they have to compete with other routine works as well. This is really challenged with other activities like the measles outbreak response. And influenza outbreak response and dengue. Where it's on the public health workers that need to be taking it into consideration. So this is really challenging in terms of the competing with other activities that also needs to be addressed at the same time as well.
Dr Stephanie Williams 14:07
I think that's a very common challenge. And you mentioned from the least FETP and outbreak response perspective, the measles and the dengue outbreaks. What about the challenges to the public health workforce in Lao for the longer term infectious diseases, the HIV, TB and the other infectious diseases that also require public health workforce attention and planning? How's that going?
Dr Bouaphanh Khamphaphongphane 14:37
I think I mentioned because of we have to competing with other public health program as well, particularly immunization activity, then we have to keep our momentum to maintain our surveillance quality in terms of performance indicators for vaccine preventable disease surveillance. As well Laos also used to have outbreaks of TB, until the circulating vaccine over Laos in 2015. And also the immunization coverage on Laos. So how we can maintain our surveillance system into our qualities and early detection for those, it's really challenging. So we have to mobilize and keep changing our strategy instead of working only with COVID-19 only. We will try to change our direction to organising this consistent way of talking about COVID-19. issue. Then we also talking about the surveillance of vaccine preventable disease, including COVID-19 and others. For HIV and malaria, my centre isn't responsible for HIV testing or surveillance of malaria. But in terms of even the last one, we still need to keep our eye on that. But beside that as the TOR of the NCLE we also carrying out the laboratory works, where we also have to supervise the quality testing for HIV AIDS program. And also now we try to working together the TB centre that how we can harmonize the GeneXpert technique to support laboratory capacity by expanding the capacity to this provincial level by using the GeneXpert that can reduce the workload for NCLE a lot if we can move forward like that.
Dr Stephanie Williams 16:46
So you're saying NCLE, which is the National Center for Laboratory and Epidemiology, who’s got a role in the diagnosis and terrific to hear that the point of care diagnosis with Gene expert is reducing the workload of NCLE. I want to turn to my last question, which is you mentioned that a bit earlier about pandemic fatigue, but COVID-19 may continue for many years to come. In your role, in your multiple roles, how do you keep up the energy and momentum?
Dr Bouaphanh Khamphaphongphane 17:23
This just happened to me yesterday and today, how can I keep my momentum? I think one thing we have to do from my personal standpoint, we have to set priorities. Then we have to decide which one is urgent and important, then setting up the priority can help you to delegate some work to other colleagues and to a colleague or your staff. Thinking I have to select which one is the most fitting to my role, less responsibility. This one thing that also my personal point of view, even if I'm too tired to keep my momentum and energy, I try to change my work-life balance. So, even if I'm too tired, but I have to switch off my mobile, I go back to home and then change my clothes to do some exercise to keep my energy. Because even if you feel tired but you do nothing when you get back home, it you make you more fatigued and very exhausted. So, I try to do every evening exercise, at least 30 minutes walking. That is my routine, practice and also working in the public health field like us, we need to also have some work-life balance, some social activity at this moment. This is also how we can keep tightly between work, family and then personal life. This is how I try to practice recently, otherwise you will be not only be fatigued from the prolonged pandemic but also from office syndrome as well. That work-life balance is especially important and how to keep doing exercise regularly is also good for your health and your brain as well.
Dr Stephanie Williams 19:42
Thank you, Dr Bouaphanh. Thank you for reminding us of the importance of disconnecting and going for a walk and making time for yourself to enable you to continue to lead well. And thanks also for your insights about honesty and communication from the early phases and remember us about the strength of networks to support the workforce in response to COVID-19. It's been terrific to talk with you today. And I wish you very well for the next phase of our pandemic response.
Dr Bouaphanh Khamphaphongphane 20:21
Thank you. But beside that is not only our FETP network program, but also we have to have a lot of support from development partners, for example, the special technical agencies, like the [United States] CDC, and the development partners like Australia’s DFAT program, and also many key partners that support us, because of without this support Lao PDR cannot achieve and can control the COVID-19 like this, we only have only 24 confirmed cases, and no deaths and all of them is very mild cases. I think not only the NCLE, but also many government partner sector plus the development partners, embassies, have given big support to the Laos government. I think I would like to take this opportunity to give thanks to our partners, our leaders, and also many people who contribute to the COVID-19 response on improving the public profile to follow the government advice during the lockdown period, that that's why we can make a success in terms of control. And then you can ask that we try to do and keep our momentum, even though the government tried to open the country because of economic situation, but we will try our best. We work together with the development partners, how we can mitigate the impact in terms of the public now and also the economy crisis.
Dr Stephanie Williams 22:05
Truly it is a team effort. Thanks for your insights today.