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Cablegate: Macau Health Care: Responding to New Realities

VZCZCXRO1824
PP RUEHCN RUEHGH RUEHVC
DE RUEHHK #1773/01 1840707
ZNR UUUUU ZZH
P 030707Z JUL 07
FM AMCONSUL HONG KONG
TO RUEHC/SECSTATE WASHDC PRIORITY 2174
INFO RUEHOO/CHINA POSTS COLLECTIVE PRIORITY
RUEHGV/USMISSION GENEVA PRIORITY 1098
RUEHRC/DEPT OF AGRICULTURE WASHDC PRIORITY
RUEAUSA/DEPT OF HHS WASHINGTON DC PRIORITY
RUEHPH/CDC ATLANTA GA PRIORITY

UNCLAS SECTION 01 OF 03 HONG KONG 001773

SIPDIS

SIPDIS
SENSITIVE

STATE FOR EAP/CM AND EAP/EP TWANG
STATE FOR G/AIAG JLANGE, HFOSTER, RFENDRICK
STATE FOR M/MED AND M/MEDEX PETER WOOD
STATE FOR INR/EAP
HHS FOR OGHA - STEIGER, BHAT
BANGKOK FOR RMO, CDC
STATE PLEASE PASS TO USDA FOR DU/US LAMBERT
BEIJING FOR DSELIGSOHN

E.O. 12958: N/A
TAGS: ECON TBIO SENV EAGR AMED KFLU HK CH
SUBJECT: MACAU HEALTH CARE: RESPONDING TO NEW REALITIES
AND OPPORTUNITIES

REF: A. HONG KONG 189
B. HONG KONG 193
C. HONG KONG 1510
D. HONG KONG 1661

1. (SBU) Macau's health care system is coping wth the
territory's quick economic expansion, rapd population
growth, and large influx of tourist. A system that was
created to care for 400,000residents now provides health
care services to oer 500,000 people and approximaely 21
million tourists (and rising) per year. While existing
health care facilities are able to provide preventive care to
local residents, health care officials acknowledge that
emergency response capabilities must be expanded. Macau
experiences a shortage of trained medical professionals --
particularly specialized physicians, nurses, and physical
therapists -- and is looking to mainland China to fill the
gap.

2. (SBU) Macau's Center for Disease Control and Prevention
greatly depends on Hong Kong and other international partners
for information on emerging infectious diseases and how to
develop response strategies. Macau plans to follow Hong
Kong's lead in responding to an Avian Influenza (AI) or other
pandemic. Tuberculosis, HIV/AIDS and dengue fever also
remain immediate public health concerns. A recent health
survey by Macau Polytechnic University reveals that the local
sex industry could contribute to the expansion of AIDS in the
region. (NOTE: This cable follows previous reports on the
strains of rapid development on Macau's existing public
infrastructure and how the Macau Special Administrative
Region Government (MSARG) plans to respond. See reftels.)
END SUMMARY.

----------
BACKGROUND
----------

3. (SBU) Macau's health care infrastructure, developed under
Portuguese rule, envisioned universal health care coverage
for a population of 400,000 through a system of two hospitals
and six health care clinics. These facilities are largely
geared to serve the population of the urban Macau peninsula,
while two satellite facilities serve the populations of the
outlying islands of Taipa and Coloane. (Note: Macau, with a
current population of over 500,000, consists of the Macau
peninsula, two islands, and Cotai, a 16 kilometer landfill
area between the islands. Over the next few years, Cotai
will become the heart of Macau's casino, gambling and
convention industry.)

4. (SBU) Currently, the health care system's annual budget of
1.7 billion patacas (approx. US$200 million) is financed
through government revenue, which has increased recently due
to the liberalization of the gaming industry. The Department
of Health has a staff of 100, including nine public health
physicians, 12 public health "technicians," two public health
nurses, and 33 sanitary inspectors. All of these technical
specialists could be mobilized during a public health
emergency. The Department of Health also contains Macau's
Center for Disease Control and Prevention, which employs
three physicians. Macau's two functional hospitals -- a
government facility and a private facility -- are
supplemented by an recently-opened private hospital at Macau
University of Science and Technology. This small
experimental facility combines western and traditional
medicine. Macau residents receive the bulk of medical
services through public clinics, which provide preventive
care and health promotion outreach at little or no cost. The
most pressing problem in the health care system now is
emergency response capabilities -- both those involving
pandemic diseases and routine emergencies. While this
problem should not impact the daily provision of medical
services, it could complicate the MSARG's ability to respond
to a crisis.

---------------------------------
Emergency Services & Future Plans

HONG KONG 00001773 002 OF 003


---------------------------------

5. (SBU) Head of Macau's Center for Disease Control and
Prevention Tong Ka Io told us that the provision of emergency
health services remains a problem for Macau, particularly in
the outlying regions of the territory. To address this
issue, Macau's private hospital recently opened a satellite
emergency clinic to serve Taipa, but Tong acknowledged that
this small facility cannot handle all emergencies. He also
stated that Macau does not yet have adequate plans for
providing health care and emergency response services in the
Cotai strip. He acknowledged that the lack of facilities in
this area could affect the MSARG's ability to respond to a
large scale public health issue in this future tourist hub,
where 16 international hotels and casinos are slated to open
in the next few years. Tong said that the government plans
to contact casino operators about response plans and believes
that some casino operators could be developing their own
facilities/plans to respond to various emergency situations.

-------------------------
Staffing & Finance Issues
-------------------------

6. (SBU) The Macau health care system faces a shortage of
qualified personnel. Macau has enough general practitioners,
but lacks specialists, trained nurses and physical
therapists. For the past few years, it has imported doctors
from prestigious hospitals and medical schools in the
Mainland. However, as salaries and private opportunities
rise on the Mainland, Macau is facing strong competition for
these professionals. Macau recently drew up a "Ten Year
Human Resource Nursing Plan" to increase the number of
nurses; Macau will have to import foreign nurses from
mainland China to meet this goal, although importing labor,
even skilled labor, is controversial with the Macau public.
Nonetheless, he underscored that bringing in non-Macanese
doctors and nurses is the most efficient and cost effective
way of expanding health care services for the population. He
also stated that increased government revenue provided
opportunities to the MSARG to reform and expand the health
care system, including hiring more personnel and creating
additional facilities. However, the public is opposed to any
changes to the health care financing system. In fact, the
government backed down to public opposition during previous
attempts at reform. Tong later acknowledged that economic
and population growth will eventually mandate changes to the
financing system even if the government does not yet have
popular support or a concrete reform proposal. Ultimately,
the Macau Secretary for Social Affairs and Culture, who is
responsible for the health sector, will make these policy
decisions.

---------------------------------------
Infectious Diseases and Avian Influenza
---------------------------------------

7. (SBU) Emerging infectious diseases are a major concern
for Macanese authorities. Given Macau's small size and its
lack of domestic research institutions, it depends largely on
Hong Kong for information and guidance. Tong noted that
Macau experienced a devastating outbreak of dengue fever in
2001, when over 1,400 people became infected. The MSARG
responded by creating and later strengthening the powers of
the Macau Center for Disease Control and Prevention. This
proactive approach helped Macau prepare for the SARS crisis,
although Tong admitted that they largely took a trial and
error approach to SARS. Macau health authorities closely
monitored the situation in Hong Kong and Guangdong,
replicated treatment and prevention techniques that appeared
to work elsewhere, and altered protocols that were not having
success in the Mainland. Despite Macau's ability to avoid a
devastating epidemic, Tong implied that they were lucky not
to have had any deaths during the SARS crisis.

8. (SBU) He noted that information sharing has improved
between Hong Kong, Guangdong and Macau. He said that Hong
Kong has been particularly helpful in allowing Macau to use

HONG KONG 00001773 003 OF 003


its laboratory services for testing, accepting patients that
Macau cannot treat effectively, and providing occasional
training. He said Macau, like Hong Kong, is completely
transparent in disclosing information on diseases, but that
mainland authorities could be more forthcoming. Tong said
that the lack of intensive care facilities remains a major
gap in Macau's pandemic preparedness plans. Macau currently
has about 40 intensive care beds and can increase that
capacity to 50 in an emergency. MSARG has plans to build a
stand-alone infectious disease facility at the government
hospital that would be used to isolate patients during a
pandemic. MSARG is also stockpiling anti-virals. In a
preventive move, the MSARG already closed poultry farms,
implemented stricter biosecurity and sanitation requirements
at wetmarkets, and mandated that imported birds be
slaughtered the day they enter Macau. Tong also cited
tuberculosis, HIV/AIDS and dengue fever as immediate public
health concerns.

--------
HIV/AIDS
--------

9. (SBU) In a separate meeting, Cheng Bing Shu, Associate
Professor in the School of Health Sciences at Macau
Polytechnic University, stated that Macau has a good system
of primary health care, but that the government does not have
an adequate handle on infectious diseases, particularly
HIV/AIDS. He told ConGen staff that HIV could become a
larger problem in Macau society. In an on-going university
survey of 3,000 Macau residents, Cheng claimed that 18% of
adult Macanese men admitted to having visited prostitutes, a
figure that Cheng stated is not reflected in current
government statistics. He said that respondents were chosen
by computer generated software to include a random, but broad
section of society. In the survey, respondents underwent
complete physicals, received blood and urine analyses, and
spoke at length about lifestyle and diet. Cheng believes
that the MSARG should take a stronger role in regulating the
sex industry, including conducting regular medical tests on
sex workers. This academic survey could have broader
implications for HIV/AIDS infections in southern China. The
final study, with a detailed methodological review, will be
published in late 2007. CongGen Hong Kong will follow up
with Macau Polytechnic University when the survey is
finalized.

-------
COMMENT
-------

10. (SBU) The MSARG recognizes the need to implement changes
to its health care system to meet the challenges of the new
Macau. With growing gaming and tourist revenue, the
government should have adequate financial resources to
implement changes and improve response services during public
health or other emergencies. However, the MSARG currently
lacks the policy and regulatory expertise, areas where the
USG could offer advice. Equally important, the MSARG appears
to lack the political will to execute broad policy changes.
As in other areas, the MSARG seems unwilling to take
potentially unpopular measures, even if those measures would
expand the availability of services and guarantee a more
sustainable health care system for the people of Macau.
Cunningham

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