%PDF-1.4
%
1 0 obj
<<
/Type /Page
/Parent 14 0 R
/Resources 4 0 R
/Contents 3 0 R
/ArtBox [ 54 54 649 896 ]
/BleedBox [ 18 18 685 932 ]
/CropBox [ 54 54 649 896 ]
/TrimBox [ 54 54 649 896 ]
/MediaBox [ 0 0 703 950 ]
>>
endobj
2 0 obj
<<
/Type /Catalog
/Pages 14 0 R
/AGFA_PSE_V (Apogee Norm PSE 1.1 18)
/AGFA_NORN_V (ES15.101 V03)
/JT 57 0 R
/AcroForm 62 0 R
/FICL:Enfocus 59 0 R
/Metadata 29 1 R
>>
endobj
3 0 obj
<< /Length 5652 >>
stream
q
/RelativeColorimetric ri
BT
/TT6 1 Tf
10 0 0 10 419.13 77.76 Tm
0.000 0.000 0.000 1.000 k
/GS2 gs
0.0045 Tc
-0.0023 Tw
[(SARS in Hong Kong: from Experience to )52.3(Action)]TJ
ET
1.000 0.400 0.000 0.000 K
0 J 0 j 2.04 w 10 M []0 d
/GS3 gs
3 i
379.890 94.620 m
593.010 94.620 l
S
1.000 0.400 0.000 0.000 k
0.96 w 1000 M
139.380 833.920 452.590 -4.690 re
B*
10 M
138.930 824.640 m
592.410 824.640 l
S
551.350 864.350 41.100 -38.850 re
f
BT
/TT7 1 Tf
14 0 0 14 567.21 843 Tm
/Cs7 cs 0.000 scn
0.0000 Tc
0.0000 Tw
(6)Tj
/TT8 1 Tf
11 0 0 11 260.85 854.04 Tm
1.000 0.400 0.000 0.000 k
0.0031 Tc
0.0024 Tw
[(Orga)35.8(nisation of He)35.8(alth a)35.8(nd He)35.8(althcare Syste)35.8(m f)14(or the)]TJ
1.8545 -1.3964 TD
0.0035 Tc
0.0018 Tw
[(Control of a)36.2(n)0.6( Outbre)36.2(a)36(k)0.5( of Communica)14.4(ble )35.8(Dise)36.2(a)57.8(s)3.1(e)]TJ
/TT9 1 Tf
0.000 0.000 0.000 1.000 k
/GS2 gs
30.0764 -69.2618 TD
0.0043 Tc
0.0000 Tw
(87)Tj
ET
q
18.000 18.000 667.000 914.000 re
W n
0.150 0.060 0.000 0.000 k
2.4 w 1000 M
/GS3 gs
142.620 706.980 446.110 -212.810 re
B*
0.48 w
139.140 710.460 453.070 -219.770 re
S
Q
/Cs7 cs 0.000 scn
/GS3 gs
127.550 866.600 476.200 -50.750 re
f
1.000 0.400 0.000 0.000 k
1000 M
139.380 837.770 69.890 -69.890 re
B*
BT
/TT7 1 Tf
36 0 0 36 162.33 794.28 Tm
/Cs7 cs 0.000 scn
0.0000 Tc
(6)Tj
/TT8 1 Tf
18 0 0 18 226.77 822 Tm
1.000 0.400 0.000 0.000 k
-0.0103 Tc
0.0014 Tw
[(Orga)36.4(nisation of He)29.7(alth a)36.4(nd He)29.7(althcare)]TJ
0 -1.1067 TD
[(Syste)29.9(m f)16.6(or the Control of a)29.9(n)0.6( Outbre)36.6(a)32.7(k)0.8( of)]TJ
0 -1.1133 TD
-0.0113 Tc
-0.0287 Tw
[(Communica)28.7(ble Dise)28.7(a)58.2(s)1(e)]TJ
ET
139.380 777.220 452.590 -4.690 re
B*
10 M
138.930 767.880 m
592.410 767.880 l
S
BT
13 0 0 13 153.09 687.96 Tm
0.000 0.000 0.000 1.000 k
/GS2 gs
-0.0048 Tc
0.0002 Tw
[(What have we he)32.1(ard?)]TJ
/G1 1 Tf
11 0 0 11 153.09 664.2 Tm
0.0000 Tc
0.0000 Tw
<0089>Tj
/TT10 1 Tf
13 0 0 13 167.25 664.2 Tm
-0.0027 Tc
0.0017 Tw
(It was not clear who was in overall charge of the outbreak)Tj
/G1 1 Tf
11 0 0 11 153.09 640.32 Tm
0.0000 Tc
0.0000 Tw
<0089>Tj
/TT10 1 Tf
13 0 0 13 167.25 640.32 Tm
-0.0032 Tc
0.0009 Tw
(The lines of authority between HWFB, DH and HA are unclear during the outbreak)Tj
/G1 1 Tf
11 0 0 11 153.09 616.44 Tm
0.0000 Tc
0.0000 Tw
<0089>Tj
/TT10 1 Tf
13 0 0 13 167.25 616.44 Tm
0.0014 Tc
0.0095 Tw
[(The relationships between HA)38.3( Board, HA)38.3( head of)10.6(fice, advisory committees, hospital)]TJ
0 -1.4031 TD
-0.0030 Tc
0.0014 Tw
(clusters, and hospital executives are unclear during the outbreak)Tj
/G1 1 Tf
11 0 0 11 153.09 574.44 Tm
0.0000 Tc
0.0000 Tw
<0089>Tj
/TT10 1 Tf
13 0 0 13 167.25 574.44 Tm
-0.0123 Tc
-0.0258 Tw
(DH does not have the management structure or resources to deal with a major outbreak)Tj
/G1 1 Tf
11 0 0 11 153.09 550.56 Tm
0.0000 Tc
0.0000 Tw
<0089>Tj
/TT10 1 Tf
13 0 0 13 167.25 550.56 Tm
-0.0026 Tc
0.0019 Tw
[(The healthcare system is not suf)15.9(ficiently flexible to respond to a major outbreak)]TJ
/G1 1 Tf
11 0 0 11 153.09 526.68 Tm
0.0000 Tc
0.0000 Tw
<0089>Tj
/TT10 1 Tf
13 0 0 13 167.25 526.68 Tm
-0.0011 Tc
0.0049 Tw
[(The relationship between the public/private hospitals and DHs regional of)17.4(fices could)]TJ
T*
-0.0036 Tc
0.0000 Tw
(be improved)Tj
/TT8 1 Tf
-2.1785 -4.4585 TD
-0.0046 Tc
(INTRODUCTION)Tj
/TT10 1 Tf
0 -2.2708 TD
0.0261 Tc
0.0539 Tw
[(6)28.5(.)28.5(1)-2106.2(In any outbreak of communicable)]TJ
0 -1.4031 TD
-0.0065 Tc
-0.0102 Tw
(diseases, and particularly in major incidents, it)Tj
0 -1.3938 TD
-0.0162 Tc
-0.0389 Tw
(is important that one person is in overall charge.)Tj
0 -1.4031 TD
0.0196 Tc
0.0410 Tw
(This leadership role becomes critical if the)Tj
T*
-0.0110 Tc
-0.0221 Tw
(outbreak is serious and has a high political and)Tj
0 -1.3938 TD
0.0309 Tc
0.0615 Tw
(media profile, or crosses geographical or)Tj
0 -1.4031 TD
0.0317 Tc
0.0644 Tw
(organisational boundaries and requires a)Tj
T*
0.0458 Tc
0.0877 Tw
(coordinated response. If an outbreak is)Tj
0 -1.3938 TD
0.0219 Tc
0.0462 Tw
(managed by various organisations without)Tj
0 -1.4031 TD
0.0152 Tc
0.0339 Tw
(proper coordination, both public health and)Tj
T*
-0.0031 Tc
0.0013 Tw
(public confidence are undermined.)Tj
/TT8 1 Tf
18.5354 16.2738 TD
0.0095 Tc
0.1936 Tw
[(ROLES AND )-37.3(RESPONSIBILITIES)]TJ
0 -1.3938 TD
0.0287 Tc
0.1787 Tw
[(WITHIN )-38.5(HWFB AND D)5.3(H)]TJ
/TT10 1 Tf
0 -2.28 TD
-0.0020 Tc
0.0039 Tw
[(6.2)-2134.3(The SARS epidemic has highlighted)]TJ
0 -1.3938 TD
-0.0054 Tc
-0.0069 Tw
(several deficiencies and ambiguities that exist)Tj
0 -1.4031 TD
0.0043 Tc
0.0141 Tw
(in the relationships between HWFB \(a policy)Tj
T*
-0.0050 Tc
-0.0051 Tw
(bureau\) and DH \(a department\), and between)Tj
0 -1.3938 TD
-0.0035 Tc
0.0006 Tw
(DH and the rest of the healthcare community.)Tj
0 -1.4031 TD
0.0212 Tc
0.0436 Tw
(It has also amplified tensions between the)Tj
T*
0.0184 Tc
0.0400 Tw
(political structure and the professional and)Tj
0 -1.3938 TD
-0.0025 Tc
0.0038 Tw
(administrative structure.)Tj
0 -2.4923 TD
0.0128 Tc
0.0282 Tw
[(6)15.2(.)15.2(3)-2119.5(Within the Hong Kong system, it is)]TJ
0 -1.4031 TD
-0.0133 Tc
-0.0308 Tw
(not clear who performs the function of surgeon)Tj
0 -1.3938 TD
0.0225 Tc
0.0454 Tw
[(general or chief medical of)22.5(ficer. I)-5.2(n)20.3( )]TJ
14.4699 0 TD
0.0022 Tc
0.0000 Tw
(other)Tj
-14.4699 -1.4031 TD
-0.0169 Tc
0.0121 Tw
(words, who is the person responsible for giving)Tj
T*
-0.0195 Tc
0.0077 Tw
(professional advice to SHWF and Government,)Tj
0 -1.3938 TD
-0.0281 Tc
-0.0154 Tw
[(and providing professiona)8.8(l)-19.9( )]TJ
9.025 0 TD
-0.0082 Tc
-0.0179 Tw
(leadership, on public)Tj
ET
Q
endstream
endobj
4 0 obj
<<
/ProcSet [ /PDF /Text ]
/Font << /TT6 5 0 R /TT7 6 0 R /TT8 7 0 R /TT9 8 0 R /TT10 9 0 R /G1 10 0 R >>
/ExtGState << /GS2 11 0 R /GS3 12 0 R >>
/ColorSpace << /Cs7 13 0 R >>
>>
endobj
5 0 obj
<<
/Type /Font
/Subtype /TrueType
/FirstChar 32
/LastChar 120
/Widths [ 228 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 228 0 0 0 0
0 0 547 0 0 0 547 0 0 592 0 0 547 0 0 0 0 0 0 592 547 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 410 0 456 228 456 0 182 0 0 0 683 456 456 456
0 273 0 228 0 0 0 410 ]
/Encoding /WinAnsiEncoding
/BaseFont /FDCDGD+ArialNarrow,Italic
/FontDescriptor 35 0 R
>>
endobj
6 0 obj
<<
/Type /Font
/Subtype /TrueType
/FirstChar 54
/LastChar 54
/Widths [ 667 ]
/Encoding /WinAnsiEncoding
/BaseFont /FDCDHE+ArialBlack
/FontDescriptor 37 0 R
>>
endobj
7 0 obj
<<
/Type /Font
/Subtype /TrueType
/FirstChar 32
/LastChar 121
/Widths [ 278 0 0 0 0 0 0 238 0 0 0 0 0 0 0 278 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 611 0 722 722 722 722 667 611 778 722 278 0 722 611 833 722 778
667 0 722 667 611 722 667 944 0 0 0 0 0 0 0 0 0 556 611 556 611
556 333 611 611 278 0 556 278 889 611 611 0 0 389 556 333 611 556
778 0 556 ]
/Encoding /WinAnsiEncoding
/BaseFont /FDCDHF+Arial,Bold
/FontDescriptor 39 0 R
>>
endobj
8 0 obj
<<
/Type /Font
/Subtype /TrueType
/FirstChar 32
/LastChar 117
/Widths [ 228 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 456 456 456 0 0 0 0 456 456 456
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 501 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 456 501 456 501 456 0 501 501 228 0 456 228 729
501 501 501 0 319 456 273 501 ]
/Encoding /WinAnsiEncoding
/BaseFont /FDCDHG+ArialNarrow,Bold
/FontDescriptor 41 0 R
>>
endobj
9 0 obj
<<
/Type /Font
/Subtype /TrueType
/FirstChar 32
/LastChar 150
/Widths [ 228 0 0 0 0 0 0 0 273 273 0 0 228 273 228 228 456 456 456 456 456
456 456 456 456 456 0 0 0 0 0 456 0 547 547 592 592 547 501 638
592 228 410 547 0 683 0 638 547 0 592 547 501 0 0 774 0 0 0 0 0
0 0 0 0 456 456 410 456 456 228 456 456 182 182 410 182 683 456
456 456 456 273 410 228 456 410 592 410 410 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 182 182 273 273 0 456 ]
/Encoding /WinAnsiEncoding
/BaseFont /FDCDJH+ArialNarrow
/FontDescriptor 43 0 R
>>
endobj
10 0 obj
<<
/Type /Font
/Subtype /Type0
/BaseFont /Wingdings-Identity-H
/Encoding /Identity-H
/DescendantFonts [ 45 0 R ]
>>
endobj
11 0 obj
<<
/Type /ExtGState
/SA true
/SM 0.02
/OP true
/op true
/OPM 1
/BG2 /Default
/UCR2 /Default
/TR /Identity
>>
endobj
12 0 obj
<<
/Type /ExtGState
/SA true
/SM 0.02
/OP false
/op false
/OPM 1
/BG2 /Default
/UCR2 /Default
/TR /Identity
>>
endobj
13 0 obj
[
/Separation /All /DeviceCMYK 16 0 R
]
endobj
14 0 obj
<<
/Type /Pages
/Kids [ 1 0 R 17 0 R 20 0 R 23 0 R 26 0 R ]
/Count 5
/MediaBox [ 0 0 703 950 ]
>>
endobj
16 0 obj
<< /FunctionType 4 /Domain [ 0 1 ] /Range [ 0 1 0 1 0 1 0 1 ] /Length 20
/Filter /FlateDecode >>
stream
HN)-PZ. (
endstream
endobj
17 0 obj
<<
/Type /Page
/Parent 14 0 R
/Resources 19 0 R
/Contents 18 0 R
/ArtBox [ 54 54 649 896 ]
/BleedBox [ 18 18 685 932 ]
/CropBox [ 54 54 649 896 ]
/TrimBox [ 54 54 649 896 ]
/MediaBox [ 0 0 703 950 ]
>>
endobj
18 0 obj
<< /Length 6498 >>
stream
q
/RelativeColorimetric ri
1.000 0.400 0.000 0.000 k
1.000 0.400 0.000 0.000 K
0 J 0 j 0.96 w 1000 M []0 d
/GS3 gs
3 i
111.030 833.920 452.590 -4.690 re
B*
10 M
110.590 824.640 m
564.070 824.640 l
S
BT
/TT6 1 Tf
10 0 0 10 110.59 77.76 Tm
0.000 0.000 0.000 1.000 k
/GS2 gs
0.0045 Tc
-0.0023 Tw
[(SARS in Hong Kong: from Experience to )52.3(Action)]TJ
ET
2.04 w
/GS3 gs
109.990 94.620 m
323.110 94.620 l
S
1.000 0.400 0.000 0.000 k
110.550 864.350 41.100 -38.850 re
f
BT
/TT7 1 Tf
14 0 0 14 126.43 843 Tm
/Cs7 cs 0.000 scn
0.0000 Tc
0.0000 Tw
(6)Tj
/TT8 1 Tf
11 0 0 11 163.03 854.04 Tm
1.000 0.400 0.000 0.000 k
0.0031 Tc
0.0024 Tw
[(Orga)35.8(nisation of He)35.8(alth a)35.8(nd He)35.8(althcare Syste)24.9(m f)24.9(or the)]TJ
0 -1.3964 TD
0.0035 Tc
0.0018 Tw
[(Control of a)36.2(n)0.6( Outbre)36.2(a)36(k)0.5( of Communica)14.4(ble )35.8(Dise)36.2(a)57.8(s)3.1(e)]TJ
/TT9 1 Tf
0.000 0.000 0.000 1.000 k
/GS2 gs
-7.4836 -69.2618 TD
0.0043 Tc
0.0000 Tw
(88)Tj
/TT10 1 Tf
13 0 0 13 110.59 783.6001 Tm
-0.0081 Tc
-0.0147 Tw
[(health and healthcare policy matters? )19.6(There is)]TJ
0 -1.4031 TD
0.0253 Tc
0.0528 Tw
(also an imbalance between responsibility,)Tj
0 -1.3938 TD
0.0338 Tc
0.0669 Tw
(authority and accountability in the health)Tj
0 -1.4031 TD
-0.0155 Tc
-0.0408 Tw
(system. For example, SHWF has accountability)Tj
T*
0.0021 Tc
0.0101 Tw
(for the health system as a whole, both public)Tj
0 -1.3938 TD
-0.0067 Tc
-0.0109 Tw
(and private, but statutory public health powers)Tj
0 -1.4031 TD
0.0290 Tc
0.0547 Tw
[(are vested in the Director of Health. )47.4(As a)]TJ
T*
-0.0079 Tc
-0.0141 Tw
(consequence of these factors, and because of)Tj
0 -1.3938 TD
0.0022 Tc
0.0106 Tw
(his professional background, SHWF became)Tj
0 -1.4031 TD
0.0086 Tc
0.0214 Tw
(directly involved in the operation of both the)Tj
T*
-0.0136 Tc
-0.0319 Tw
(hospital and public health services at the height)Tj
0 -1.3938 TD
0.0343 Tc
0.0637 Tw
(of the SARS epidemic. Since SHWF is a)Tj
0 -1.4031 TD
-0.0009 Tc
0.0051 Tw
(political appointee, there is no guarantee that)Tj
T*
0.0397 Tc
0.0757 Tw
(any future policy secretary will have the)Tj
0 -1.3938 TD
-0.0025 Tc
0.0020 Tw
(appropriate professional expertise to respond)Tj
0 -1.4031 TD
-0.0028 Tc
0.0039 Tw
(in this way.)Tj
0 -2.4923 TD
-0.0115 Tc
-0.0307 Tw
[(6)-9.1(.)-9.1(4)-2143.8(The current organisational separation)]TJ
0 -1.3938 TD
-0.0092 Tc
0.0235 Tw
[(b)-14.7(etween HWFB and DH may lead to a lack of)]TJ
0 -1.4031 TD
0.0164 Tc
0.0731 Tw
(coherence in policy development, decision)Tj
T*
-0.0312 Tc
-0.0277 Tw
(making, funding and resource allocation, systems)Tj
0 -1.3938 TD
-0.0074 Tc
-0.0137 Tw
[(for monitoring, audit and accountability)57.2(. )20.7(There)]TJ
0 -1.4031 TD
0.0155 Tc
0.0346 Tw
[(is also insuf)24.7(ficient professional expertise in)]TJ
T*
-0.0124 Tc
-0.0295 Tw
(HWFB to support aspects of policy formulation.)Tj
0 -1.3938 TD
-0.0017 Tc
0.0038 Tw
(Organisational design needs to be functional,)Tj
0 -1.4031 TD
0.0549 Tc
0.1038 Tw
[(both to ensure the ef)18(ficient day-to-day)]TJ
T*
-0.0069 Tc
-0.0097 Tw
(management of a range of services, and to be)Tj
0 -1.3938 TD
0.0050 Tc
0.0148 Tw
(able to adopt a strong command and control)Tj
0 -1.4031 TD
0.0096 Tc
0.0237 Tw
[(mode to ef)9.6(fectively respond to an epidemic.)]TJ
T*
0.0157 Tc
0.0322 Tw
(There needs to be a clear conductor of the)Tj
0 -1.3938 TD
-0.0030 Tc
0.0000 Tw
(health orchestra.)Tj
/G1 1 Tf
14 0 0 14 124.75 208.44 Tm
1.000 0.400 0.000 0.000 k
/GS3 gs
0.0000 Tc
<008a>Tj
/TT10 1 Tf
13 0 0 13 138.91 208.44 Tm
0.0335 Tc
0.0663 Tw
(The Government should review the)Tj
0 -1.44 TD
0.0702 Tc
0.1346 Tw
(organisational structure and the)Tj
0 -1.4031 TD
0.0234 Tc
0.0480 Tw
(relationship between HWFB and the)Tj
0 -1.3938 TD
0.0152 Tc
0.0365 Tw
(constituent Government departments)Tj
18.5354 48.48 TD
-0.0076 Tc
-0.0127 Tw
(under the Bureau in the areas of health,)Tj
0 -1.4031 TD
-0.0019 Tc
0.0029 Tw
(social welfare and food. Consideration)Tj
0 -1.3938 TD
-0.0126 Tc
-0.0282 Tw
(should be given to merging the functions)Tj
0 -1.4031 TD
-0.0010 Tc
0.0048 Tw
(of separate departments within HWFB,)Tj
T*
0.0060 Tc
0.0166 Tw
(headed by SHWF, in order to improve)Tj
0 -1.3938 TD
-0.0047 Tc
-0.0038 Tw
(the capacity for coordination across the)Tj
0 -1.4031 TD
0.0206 Tc
0.0442 Tw
(departments, and to facilitate policy-)Tj
T*
0.0122 Tc
0.0288 Tw
(making and commissioning for health)Tj
0 -1.3938 TD
-0.0027 Tc
0.0039 Tw
(protection matters.)Tj
/G1 1 Tf
14 0 0 14 365.71 613.92 Tm
0.0000 Tc
0.0000 Tw
<008a>Tj
/TT10 1 Tf
13 0 0 13 379.87 613.92 Tm
0.0272 Tc
0.0538 Tw
(The Bureau under the leadership of)Tj
0 -1.44 TD
0.0093 Tc
0.0240 Tw
(SHWF should consider what changes)Tj
0 -1.3938 TD
0.0574 Tc
0.1053 Tw
(are necessary to ensure that the)Tj
0 -1.4031 TD
0.0177 Tc
0.0385 Tw
(necessary systems to coordinate the)Tj
T*
-0.0045 Tc
-0.0039 Tw
(activities and responsibilities of DH and)Tj
0 -1.3938 TD
-0.0156 Tc
-0.0346 Tw
(HA and the private sector are all in place.)Tj
/TT8 1 Tf
0.000 0.000 0.000 1.000 k
/GS2 gs
-2.1785 -3.5262 TD
0.0113 Tc
0.2154 Tw
(LEADERSHIP IN OUTBREAK)Tj
0 -1.4031 TD
0.0109 Tc
0.1806 Tw
[(MANAGEMENT AND )-38.7(CONTROL)]TJ
/TT10 1 Tf
0 -2.2708 TD
0.0076 Tc
0.0218 Tw
[(6)10(.)10(5)-2124.7(Many individuals and organisations)]TJ
0 -1.4031 TD
-0.0111 Tc
-0.0230 Tw
(are involved in the management of any serious)Tj
T*
-0.0162 Tc
-0.0430 Tw
[(outbreaks of communicable disease. )20.8(The range)]TJ
0 -1.3938 TD
0.0155 Tc
0.0340 Tw
(of organisations will vary depending on the)Tj
0 -1.4031 TD
-0.0049 Tc
-0.0030 Tw
(nature of the incident and the type of infection)Tj
T*
0.0251 Tc
0.0507 Tw
(involved. However, it is important, both to)Tj
0 -1.3938 TD
0.0001 Tc
0.0077 Tw
[(ensure ef)9.3(fective coordination and to maintain)]TJ
0 -1.4031 TD
0.0015 Tc
0.0096 Tw
(public confidence, that one individual is seen)Tj
T*
-0.0029 Tc
0.0013 Tw
(to lead the response.)Tj
0 -2.4831 TD
0.0304 Tc
0.0600 Tw
[(6)32.8(.)32.8(6)-2101.9(In practice, this will often involve)]TJ
0 -1.4031 TD
-0.0145 Tc
-0.0392 Tw
(coordinating the activities of various individuals,)Tj
0 -1.3938 TD
-0.0034 Tc
0.0007 Tw
(departments and organisations, usually in the)Tj
0 -1.4031 TD
-0.0033 Tc
(context of an outbreak control team. It follows)Tj
T*
-0.0114 Tc
-0.0263 Tw
(that the person will have professional expertise)Tj
0 -1.3938 TD
-0.0124 Tc
-0.0295 Tw
(in communicable disease control, will be drawn)Tj
0 -1.4031 TD
0.0813 Tc
0.1493 Tw
(from an appropriate level within the)Tj
ET
Q
endstream
endobj
19 0 obj
<<
/ProcSet [ /PDF /Text ]
/Font << /TT6 5 0 R /TT7 6 0 R /TT8 7 0 R /TT9 8 0 R /TT10 9 0 R /G1 10 0 R >>
/ExtGState << /GS2 11 0 R /GS3 12 0 R >>
/ColorSpace << /Cs7 13 0 R >>
>>
endobj
20 0 obj
<<
/Type /Page
/Parent 14 0 R
/Resources 22 0 R
/Contents 21 0 R
/ArtBox [ 54 54 649 896 ]
/BleedBox [ 18 18 685 932 ]
/CropBox [ 54 54 649 896 ]
/TrimBox [ 54 54 649 896 ]
/MediaBox [ 0 0 703 950 ]
>>
endobj
21 0 obj
<< /Length 7330 >>
stream
q
/RelativeColorimetric ri
BT
/TT6 1 Tf
10 0 0 10 419.13 77.76 Tm
0.000 0.000 0.000 1.000 k
/GS2 gs
0.0045 Tc
-0.0023 Tw
[(SARS in Hong Kong: from Experience to )52.3(Action)]TJ
ET
1.000 0.400 0.000 0.000 K
0 J 0 j 2.04 w 10 M []0 d
/GS3 gs
3 i
379.890 94.620 m
593.010 94.620 l
S
1.000 0.400 0.000 0.000 k
0.96 w 1000 M
139.380 833.920 452.590 -4.690 re
B*
10 M
138.930 824.640 m
592.410 824.640 l
S
551.350 864.350 41.100 -38.850 re
f
BT
/TT7 1 Tf
14 0 0 14 567.21 843 Tm
/Cs7 cs 0.000 scn
0.0000 Tc
0.0000 Tw
(6)Tj
/TT8 1 Tf
11 0 0 11 260.85 854.04 Tm
1.000 0.400 0.000 0.000 k
0.0031 Tc
0.0024 Tw
[(Orga)35.8(nisation of He)35.8(alth a)35.8(nd He)35.8(althcare Syste)35.8(m f)14(or the)]TJ
1.8545 -1.3964 TD
0.0035 Tc
0.0018 Tw
[(Control of a)36.2(n)0.6( Outbre)36.2(a)36(k)0.5( of Communica)14.4(ble )35.8(Dise)36.2(a)57.8(s)3.1(e)]TJ
/TT9 1 Tf
0.000 0.000 0.000 1.000 k
/GS2 gs
30.0764 -69.2618 TD
0.0043 Tc
0.0000 Tw
(89)Tj
ET
0.150 0.060 0.000 0.000 k
0.48 w 1000 M
/GS3 gs
139.140 795.510 212.120 -302.070 re
B*
1.000 0.400 0.000 0.000 k
0.96 w
139.380 795.270 211.640 -38.740 re
B*
BT
12.5 0 0 12.5 189.09 778.8 Tm
/Cs7 cs 0.000 scn
-0.0019 Tc
-0.0040 Tw
(Leadership in outbreak)Tj
-0.3552 -1.4016 TD
-0.0022 Tc
(management and control)Tj
/TT10 1 Tf
12 0 0 12 150.21 736.92 Tm
0.000 0.000 0.000 1.000 k
/GS2 gs
0.0040 Tc
0.0422 Tw
(The person who will lead the response will)Tj
0 -1.25 TD
-0.0200 Tc
0.0000 Tw
(usually fulfill most or all of the following roles )Tj
/G1 1 Tf
13 0 0 13 153.09 699.12 Tm
1.000 0.400 0.000 0.000 k
/GS3 gs
0.0000 Tc
<008a>Tj
/TT10 1 Tf
12 0 0 12 167.25 699.12 Tm
0.000 0.000 0.000 1.000 k
/GS2 gs
0.0011 Tc
0.0028 Tw
(Demonstrating clear leadership and)Tj
0 -1.31 TD
0.0001 Tc
0.0000 Tw
(accountability)Tj
/G1 1 Tf
13 0 0 13 153.09 663.6 Tm
1.000 0.400 0.000 0.000 k
/GS3 gs
0.0000 Tc
<008a>Tj
/TT10 1 Tf
12 0 0 12 167.25 663.6 Tm
0.000 0.000 0.000 1.000 k
/GS2 gs
0.0165 Tc
0.0312 Tw
(Making key decisions on outbreak)Tj
T*
0.0000 Tc
0.0000 Tw
(control measures)Tj
/G1 1 Tf
13 0 0 13 153.09 627.96 Tm
1.000 0.400 0.000 0.000 k
/GS3 gs
<008a>Tj
/TT10 1 Tf
12 0 0 12 167.25 627.96 Tm
0.000 0.000 0.000 1.000 k
/GS2 gs
0.0918 Tc
0.1729 Tw
(Deploying and redistributing)Tj
T*
0.0006 Tc
0.0021 Tw
(manpower and resources)Tj
/G1 1 Tf
13 0 0 13 153.09 592.44 Tm
1.000 0.400 0.000 0.000 k
/GS3 gs
0.0000 Tc
0.0000 Tw
<008a>Tj
/TT10 1 Tf
12 0 0 12 167.25 592.44 Tm
0.000 0.000 0.000 1.000 k
/GS2 gs
-0.0086 Tc
-0.0302 Tw
[(Providing advice to Principal Of)11.4(ficials)]TJ
/G1 1 Tf
13 0 0 13 153.09 571.44 Tm
1.000 0.400 0.000 0.000 k
/GS3 gs
0.0000 Tc
0.0000 Tw
<008a>Tj
/TT10 1 Tf
12 0 0 12 167.25 571.44 Tm
0.000 0.000 0.000 1.000 k
/GS2 gs
0.0472 Tc
0.0896 Tw
(Ensuring collaboration between)Tj
T*
0.0004 Tc
0.0021 Tw
(organisations and agencies)Tj
/G1 1 Tf
13 0 0 13 153.09 535.8 Tm
1.000 0.400 0.000 0.000 k
/GS3 gs
0.0000 Tc
0.0000 Tw
<008a>Tj
/TT10 1 Tf
12 0 0 12 167.25 535.8 Tm
0.000 0.000 0.000 1.000 k
/GS2 gs
0.0399 Tc
0.0736 Tw
(Coordinating information flow to)Tj
0 -1.3 TD
0.0005 Tc
0.0021 Tw
(media and public.)Tj
13 0 0 13 138.93 446.88 Tm
0.0283 Tc
0.0558 Tw
(organisation, and will have the respect of)Tj
0 -1.4031 TD
-0.0156 Tc
-0.0443 Tw
[(professional colleagues. )21.3(The person concerned)]TJ
T*
0.0017 Tc
0.0090 Tw
(will normally chair the outbreak control team,)Tj
0 -1.3938 TD
-0.0074 Tc
-0.0110 Tw
(will lead and guide decisions that are made by)Tj
0 -1.4031 TD
0.0288 Tc
0.0555 Tw
(the team, and will delegate to other team)Tj
T*
-0.0149 Tc
-0.0366 Tw
(members many of the functions outlined above.)Tj
0 -2.4831 TD
-0.0120 Tc
-0.0256 Tw
[(6)-9.6(.)-9.6(7)-2144.3(DH, as the public health authority and)]TJ
0 -1.4031 TD
-0.0076 Tc
-0.0134 Tw
(from a population perspective, should take the)Tj
0 -1.3938 TD
-0.0088 Tc
-0.0179 Tw
(lead in outbreak control, regardless of whether)Tj
0 -1.4031 TD
0.0508 Tc
0.0943 Tw
(the outbreak occurs in hospitals or the)Tj
T*
0.0309 Tc
0.0625 Tw
[(community. Most communicable disease)]TJ
0 -1.3938 TD
-0.0009 Tc
0.0044 Tw
(outbreaks \(eg food poisoning\) are likely to be)Tj
0 -1.4031 TD
-0.0040 Tc
-0.0004 Tw
[(handled at the regional of)14.5(fice level of DH as a)]TJ
T*
0.0170 Tc
0.0346 Tw
(matter of routine, and should be led by the)Tj
0 -1.3938 TD
-0.0035 Tc
0.0012 Tw
(senior communicable disease epidemiologist/)Tj
0 -1.4031 TD
-0.0027 Tc
0.0023 Tw
(public health physician for that area.)Tj
18.5354 47.9908 TD
0.0035 Tc
0.0135 Tw
[(6)5.9(.)5.9(8)-2128.8(In a major outbreak, responsibilities)]TJ
0 -1.4031 TD
0.0302 Tc
0.0601 Tw
[(and accountabilities may change. )48.8(A)41.7( more)]TJ
0 -1.3938 TD
0.0024 Tc
0.0105 Tw
(senior person in DH may take the leadership)Tj
0 -1.4031 TD
0.0536 Tc
0.1015 Tw
(role, and other responsibilities may be)Tj
T*
0.0385 Tc
0.0725 Tw
(delegated. For example, it may be more)Tj
0 -1.3938 TD
-0.0153 Tc
-0.0390 Tw
(appropriate for another member of the outbreak)Tj
0 -1.4031 TD
0.0413 Tc
0.0775 Tw
(control team to become the main media)Tj
T*
0.0031 Tc
0.0116 Tw
(spokesperson, in order to allow the leader to)Tj
0 -1.3938 TD
0.0097 Tc
0.0238 Tw
(focus on outbreak investigation and control.)Tj
0 -1.4031 TD
0.0016 Tc
0.0096 Tw
(The constitution of the outbreak control team)Tj
T*
0.0691 Tc
0.1219 Tw
[(may also change. In a public health)]TJ
0 -1.3938 TD
-0.0162 Tc
-0.0384 Tw
(emergency, such as the SARS epidemic, it may)Tj
0 -1.4031 TD
0.0074 Tc
0.0199 Tw
(require the direct involvement of the highest)Tj
T*
0.0134 Tc
0.0291 Tw
(level of Government in order to ensure that)Tj
0 -1.3938 TD
0.0045 Tc
0.0146 Tw
[(appropriate resources are made available. )50.6(A)]TJ
0 -1.4031 TD
0.0067 Tc
0.0186 Tw
(clear distinction should continue to be made)Tj
T*
0.0028 Tc
0.0125 Tw
(between professional and political decisions,)Tj
0 -1.3938 TD
0.0005 Tc
0.0072 Tw
(and the roles of the public health service and)Tj
0 -1.4031 TD
-0.0025 Tc
0.0020 Tw
(the civil service.)Tj
/G1 1 Tf
14 0 0 14 394.05 422.76 Tm
1.000 0.400 0.000 0.000 k
/GS3 gs
0.0000 Tc
0.0000 Tw
<008a>Tj
/TT10 1 Tf
13 0 0 13 408.21 422.76 Tm
0.0040 Tc
0.0139 Tw
(The command and control structure to)Tj
0 -1.44 TD
-0.0087 Tc
-0.0161 Tw
(manage an outbreak or epidemic needs)Tj
0 -1.4031 TD
0.0206 Tc
0.0431 Tw
(to be clear. Consideration should be)Tj
0 -1.3938 TD
0.0165 Tc
0.0346 Tw
(given to the establishment of a small)Tj
0 -1.4031 TD
-0.0139 Tc
-0.0331 Tw
(command group, chaired by SHWF, with)Tj
T*
-0.0012 Tc
0.0045 Tw
(a limited number of personnel, such as)Tj
0 -1.3938 TD
-0.0090 Tc
-0.0192 Tw
(the Permanent Secretary of the Bureau,)Tj
0 -1.4031 TD
0.0260 Tc
0.0506 Tw
(the Director of Health and the Chief)Tj
T*
0.0093 Tc
0.0217 Tw
[(Executive of HA. )18.4(This body should be)]TJ
0 -1.3938 TD
0.0767 Tc
0.1423 Tw
(responsible for taking all major)Tj
0 -1.4031 TD
-0.0135 Tc
-0.0330 Tw
(decisions, such as invoking public health)Tj
T*
0.0248 Tc
0.0509 Tw
(legislation, closure of hospitals, and)Tj
0 -1.3938 TD
0.0094 Tc
0.0241 Tw
[(quarantine of residential areas. )18.7(There)]TJ
0 -1.4031 TD
-0.0051 Tc
-0.0206 Tw
[(should)-5.1( b)18.7(e)18.7( )]TJ
3.6601 0 TD
-0.0238 Tc
-0.0019 Tw
(clarity established beforehand,)Tj
-3.6601 -1.4031 TD
-0.0347 Tc
-0.0323 Tw
(as to what decisions are taken at what level)Tj
0 -1.3938 TD
0.0057 Tc
0.0159 Tw
[(a)20.6(n)20.6(d)24.2( by whom during an epidemic, in a)]TJ
ET
Q
endstream
endobj
22 0 obj
<<
/ProcSet [ /PDF /Text ]
/Font << /TT6 5 0 R /TT7 6 0 R /TT8 7 0 R /TT9 8 0 R /TT10 9 0 R /G1 10 0 R >>
/ExtGState << /GS2 11 0 R /GS3 12 0 R >>
/ColorSpace << /Cs7 13 0 R >>
>>
endobj
23 0 obj
<<
/Type /Page
/Parent 14 0 R
/Resources 25 0 R
/Contents 24 0 R
/ArtBox [ 54 54 649 896 ]
/BleedBox [ 18 18 685 932 ]
/CropBox [ 54 54 649 896 ]
/TrimBox [ 54 54 649 896 ]
/MediaBox [ 0 0 703 950 ]
>>
endobj
24 0 obj
<< /Length 6357 >>
stream
q
/RelativeColorimetric ri
1.000 0.400 0.000 0.000 k
1.000 0.400 0.000 0.000 K
0 J 0 j 0.96 w 1000 M []0 d
/GS3 gs
3 i
111.030 833.920 452.590 -4.690 re
B*
10 M
110.590 824.640 m
564.070 824.640 l
S
BT
/TT6 1 Tf
10 0 0 10 110.59 77.76 Tm
0.000 0.000 0.000 1.000 k
/GS2 gs
0.0045 Tc
-0.0023 Tw
[(SARS in Hong Kong: from Experience to )52.3(Action)]TJ
ET
2.04 w
/GS3 gs
109.990 94.620 m
323.110 94.620 l
S
1.000 0.400 0.000 0.000 k
110.550 864.350 41.100 -38.850 re
f
BT
/TT7 1 Tf
14 0 0 14 126.43 843 Tm
/Cs7 cs 0.000 scn
0.0000 Tc
0.0000 Tw
(6)Tj
/TT8 1 Tf
11 0 0 11 163.03 854.04 Tm
1.000 0.400 0.000 0.000 k
0.0031 Tc
0.0024 Tw
[(Orga)35.8(nisation of He)35.8(alth a)35.8(nd He)35.8(althcare Syste)24.9(m f)24.9(or the)]TJ
0 -1.3964 TD
0.0035 Tc
0.0018 Tw
[(Control of a)36.2(n)0.6( Outbre)36.2(a)36(k)0.5( of Communica)14.4(ble )35.8(Dise)36.2(a)57.8(s)3.1(e)]TJ
/TT9 1 Tf
0.000 0.000 0.000 1.000 k
/GS2 gs
-7.4836 -69.2618 TD
0.0043 Tc
0.0000 Tw
(90)Tj
/TT10 1 Tf
13 0 0 13 138.91 783.6001 Tm
1.000 0.400 0.000 0.000 k
/GS3 gs
0.0072 Tc
0.0192 Tw
[(major incident plan. )16.4(The authority and)]TJ
0 -1.4031 TD
0.0090 Tc
0.0224 Tw
(responsibilities of DH in all aspects of)Tj
0 -1.3938 TD
-0.0073 Tc
-0.0153 Tw
(epidemiological management, including)Tj
0 -1.4031 TD
0.0061 Tc
0.0183 Tw
(surveillance and contact tracing, need)Tj
T*
-0.0087 Tc
-0.0167 Tw
(to be clearly understood and adhered to)Tj
0 -1.3938 TD
-0.0026 Tc
0.0020 Tw
(by all parties.)Tj
/TT8 1 Tf
0.000 0.000 0.000 1.000 k
/GS2 gs
-2.1785 -3.5261 TD
0.0095 Tc
0.1936 Tw
[(ROLES AND )-37.4(RESPONSIBILITIES)]TJ
0 -1.4031 TD
0.0178 Tc
0.2115 Tw
(WITHIN HA)Tj
/TT10 1 Tf
0 -2.2708 TD
0.0500 Tc
0.0943 Tw
[(6)52.4(.)52.4(9)-2082.3(HA appears to have responded)]TJ
0 -1.4031 TD
0.0415 Tc
0.0782 Tw
(promptly both to the perceived threat of)Tj
T*
0.0065 Tc
0.0193 Tw
(community-acquired pneumonia in February)Tj
0 -1.3938 TD
0.0168 Tw
(2003 and the outbreak of SARS at Prince of)Tj
0 -1.4031 TD
0.0082 Tc
0.0217 Tw
[(W)34.4(ales Hospital \(PWH\). )45.7(A)47.4( W)17.4(orking Group on)]TJ
T*
-0.0045 Tc
-0.0052 Tw
(Severe Community-Acquired Pneumonia was)Tj
0 -1.3938 TD
-0.0010 Tc
0.0056 Tw
[(established by HA)35.9( head of)17.5(fice, and advice on)]TJ
0 -1.4031 TD
-0.0113 Tc
-0.0277 Tw
(reporting cases and infection control measures)Tj
T*
0.0171 Tc
0.0365 Tw
(to be taken were subsequently followed by)Tj
0 -1.3938 TD
0.0336 Tc
0.0638 Tw
(hospitals in HA. In response to the PWH)Tj
0 -1.4031 TD
0.0439 Tc
0.0846 Tw
(outbreak, a cluster meeting on atypical)Tj
T*
-0.0115 Tc
-0.0256 Tw
(pneumonia was established on 13 March, with)Tj
0 -1.3938 TD
0.0035 Tc
0.0141 Tw
(membership comprising senior management)Tj
0 -1.4031 TD
0.0133 Tc
0.0304 Tw
[(staf)13.3(f from the cluster)41(, chiefs of service, and)]TJ
T*
-0.0062 Tc
-0.0072 Tw
[(various clinical heads. )12.2(This made a number of)]TJ
0 -1.3938 TD
0.0377 Tc
0.0750 Tw
(decisions on infection control measures,)Tj
0 -1.4031 TD
0.0273 Tc
0.0554 Tw
(including restrictions on visiting that were)Tj
T*
0.0039 Tc
0.0145 Tw
[(speedily implemented. )50.1(A)43.1( representative from)]TJ
0 -1.3938 TD
0.0092 Tc
0.0225 Tw
[(the DH regional of)9.2(fice attended some of the)]TJ
0 -1.4031 TD
0.0066 Tc
0.0192 Tw
(hospital meetings, but coordination between)Tj
T*
-0.0183 Tc
-0.0428 Tw
(HA and DH in response to the outbreak appears)Tj
0 -1.3938 TD
-0.0108 Tc
-0.0199 Tw
[(to have been poor)44.6(. )7.4(There seems to have been)]TJ
0 -1.4031 TD
0.0709 Tc
0.1253 Tw
(a failure in the system to enable full)Tj
T*
0.0042 Tc
0.0146 Tw
(appreciation of the public health implications)Tj
0 -1.3938 TD
0.0645 Tc
0.1173 Tw
(of the hospital outbreak for the wider)Tj
0 -1.4031 TD
-0.0023 Tc
0.0000 Tw
(community.)Tj
18.5354 49.2 TD
0.0020 Tc
0.0122 Tw
[(6.10)-1678(As the epidemic developed, several)]TJ
0 -1.4031 TD
0.0035 Tc
0.0128 Tw
(tensions became evident within HA, many of)Tj
0 -1.3938 TD
0.0823 Tc
0.1500 Tw
(which were connected to failures of)Tj
0 -1.4031 TD
-0.0151 Tc
-0.0363 Tw
(communication or lack of clarity about roles and)Tj
T*
-0.0108 Tc
-0.0269 Tw
[(responsibilities. Frontline staf)16.9(f felt isolated from)]TJ
0 -1.3938 TD
0.0294 Tc
0.0615 Tw
(the decision-making process, instructions)Tj
0 -1.4031 TD
0.0136 Tc
0.0299 Tw
[(issued by HA)41.3( head of)13.6(fice were not properly)]TJ
T*
-0.0056 Tc
-0.0070 Tw
(executed in hospitals, HA Board members felt)Tj
0 -1.3938 TD
-0.0097 Tc
-0.0199 Tw
(they were not adequately involved in decisions)Tj
0 -1.4031 TD
0.0239 Tc
0.0481 Tw
(being made by the senior executives, and)Tj
T*
-0.0043 Tc
-0.0011 Tw
[(academic staf)14.2(f made statements to the media)]TJ
0 -1.3938 TD
-0.0085 Tc
-0.0136 Tw
[(on their own. )47(At the height of the epidemic, the)]TJ
0 -1.4031 TD
0.0000 Tc
0.0064 Tw
(Chief Executive of HA contracted SARS, and)Tj
T*
0.0016 Tc
0.0094 Tw
[(this had a significant impact on the ef)20.1(ficiency)]TJ
0 -1.3938 TD
0.0395 Tc
0.0749 Tw
(of the HA response, suggesting that the)Tj
0 -1.4031 TD
0.0168 Tc
0.0369 Tw
(contingency arrangements that were put in)Tj
T*
-0.0028 Tc
0.0023 Tw
(place had not been well planned.)Tj
0 -2.4831 TD
0.0011 Tc
0.0084 Tw
[(6)8.1(.)8.1(1)65.7(1)-1749(Since July 2003, HA has taken over)]TJ
0 -1.4031 TD
0.0168 Tc
0.0374 Tw
(responsibility for general out-patient clinics)Tj
T*
0.0050 Tc
0.0154 Tw
(formerly run by DH. With this change comes)Tj
0 -1.3938 TD
0.0272 Tc
0.0539 Tw
(greater responsibility for the health of the)Tj
0 -1.4031 TD
-0.0016 Tc
0.0033 Tw
(population, not just for patients in hospitals. It)Tj
T*
-0.0047 Tc
-0.0045 Tw
(might be appropriate if consideration be given)Tj
0 -1.3938 TD
0.0094 Tc
0.0218 Tw
(to change the name of HA, eg to the Health)Tj
0 -1.4031 TD
0.0027 Tc
0.0108 Tw
[(Services )48.8(Authority)67.3(, to clearly reflect its scope)]TJ
T*
0.0195 Tc
0.0410 Tw
(of responsibility to cover both hospital and)Tj
0 -1.3938 TD
-0.0048 Tc
-0.0044 Tw
(community health services. It also means that)Tj
0 -1.4031 TD
-0.0144 Tc
-0.0346 Tw
(primary care generally will need to have greater)Tj
T*
-0.0034 Tc
0.0006 Tw
(emphasis within HA and, within the context of)Tj
0 -1.3938 TD
-0.0139 Tc
-0.0337 Tw
[(a community outbreak, this will require ef)13.8(fective)]TJ
0 -1.4031 TD
0.0226 Tc
0.0461 Tw
(coordination of activities with DH and with)Tj
T*
-0.0026 Tc
0.0023 Tw
(family doctors in the private sector.)Tj
ET
Q
endstream
endobj
25 0 obj
<<
/ProcSet [ /PDF /Text ]
/Font << /TT6 5 0 R /TT7 6 0 R /TT8 7 0 R /TT9 8 0 R /TT10 9 0 R >>
/ExtGState << /GS2 11 0 R /GS3 12 0 R >>
/ColorSpace << /Cs7 13 0 R >>
>>
endobj
26 0 obj
<<
/Type /Page
/Parent 14 0 R
/Resources 28 0 R
/Contents 27 0 R
/ArtBox [ 54 54 649 896 ]
/BleedBox [ 18 18 685 932 ]
/CropBox [ 54 54 649 896 ]
/TrimBox [ 54 54 649 896 ]
/MediaBox [ 0 0 703 950 ]
>>
endobj
27 0 obj
<< /Length 6203 >>
stream
q
/RelativeColorimetric ri
BT
/TT6 1 Tf
10 0 0 10 419.13 77.76 Tm
0.000 0.000 0.000 1.000 k
/GS2 gs
0.0045 Tc
-0.0023 Tw
[(SARS in Hong Kong: from Experience to )52.3(Action)]TJ
ET
1.000 0.400 0.000 0.000 K
0 J 0 j 2.04 w 10 M []0 d
/GS3 gs
3 i
379.890 94.620 m
593.010 94.620 l
S
1.000 0.400 0.000 0.000 k
0.96 w 1000 M
139.380 833.920 452.590 -4.690 re
B*
10 M
138.930 824.640 m
592.410 824.640 l
S
551.350 864.350 41.100 -38.850 re
f
BT
/TT7 1 Tf
14 0 0 14 567.21 843 Tm
/Cs7 cs 0.000 scn
0.0000 Tc
0.0000 Tw
(6)Tj
/TT8 1 Tf
11 0 0 11 260.85 854.04 Tm
1.000 0.400 0.000 0.000 k
0.0031 Tc
0.0024 Tw
[(Orga)35.8(nisation of He)35.8(alth a)35.8(nd He)35.8(althcare Syste)35.8(m f)14(or the)]TJ
1.8545 -1.3964 TD
0.0035 Tc
0.0018 Tw
[(Control of a)36.2(n)0.6( Outbre)36.2(a)36(k)0.5( of Communica)14.4(ble )35.8(Dise)36.2(a)57.8(s)3.1(e)]TJ
/TT9 1 Tf
0.000 0.000 0.000 1.000 k
/GS2 gs
30.0764 -69.2618 TD
0.0043 Tc
0.0000 Tw
(91)Tj
/TT8 1 Tf
13 0 0 13 138.93 783.6001 Tm
0.0032 Tc
0.2384 Tw
[(RELA)77(TIONSHIP)12.4( BETWEEN)]TJ
0 -1.4031 TD
0.0014 Tc
0.2341 Tw
[(PUBLIC/PRIV)75.2(A)77.4(TE HOSPIT)66(ALS)]TJ
0 -1.3938 TD
0.0185 Tc
0.1730 Tw
[(AND DH'S )-46.1(REGIONAL)18.5( )-45.8(OFFICES)]TJ
/TT10 1 Tf
0 -2.28 TD
-0.0028 Tc
0.0000 Tw
(6.12)Tj
3.2677 0 TD
0.0250 Tc
0.0510 Tw
(The epidemic also revealed more)Tj
-3.2677 -1.3938 TD
-0.0142 Tc
-0.0377 Tw
(general weaknesses in the working relationship)Tj
0 -1.4031 TD
0.0233 Tc
0.0500 Tw
(between public/private hospitals and DHs)Tj
T*
0.0236 Tc
0.0467 Tw
[(regional of)14.4(fices. )14.4(The roles of the regional)]TJ
0 -1.3938 TD
0.0392 Tc
0.0771 Tw
[(of)11.5(fices appeared not fully recognised by)]TJ
0 -1.4031 TD
0.0081 Tc
0.0205 Tw
[(decision makers in the hospital system. )17.3(The)]TJ
T*
0.0262 Tc
0.0531 Tw
(flow of information between hospitals and)Tj
0 -1.3938 TD
0.0228 Tc
0.0460 Tw
[(regional of)22.8(fices had also not been smooth)]TJ
0 -1.4031 TD
-0.0027 Tc
0.0020 Tw
(during the epidemic.)Tj
0 -2.4923 TD
-0.0072 Tc
-0.0128 Tw
[(6.13)-1687.2(There should be regular exchange of)]TJ
0 -1.3938 TD
0.0043 Tc
0.0147 Tw
(information and meetings of infection control)Tj
0 -1.4031 TD
-0.0069 Tc
-0.0107 Tw
[(staf)20.8(f, so that the hospital staf)11.6(f are aware of the)]TJ
T*
0.0343 Tc
0.0682 Tw
(pattern and prevalence of communicable)Tj
0 -1.3938 TD
0.0060 Tc
0.0173 Tw
(diseases in the community, and the regional)Tj
0 -1.4031 TD
-0.0161 Tc
-0.0374 Tw
[(of)11.6(fices are kept informed of the state of infection)]TJ
0 -1.3938 TD
-0.0079 Tc
-0.0137 Tw
[(control in the hospitals. Such liaison meetings)]TJ
0 -1.4031 TD
0.0046 Tc
0.0155 Tw
[(facilitate greater awareness amongst staf)13.8(f of)]TJ
T*
0.0339 Tc
0.0683 Tw
(any unusual occurence of communicable)Tj
0 -1.3938 TD
0.0455 Tc
0.0852 Tw
[(diseases, locally and beyond. )17.8(The fast)]TJ
0 -1.4031 TD
0.0226 Tc
0.0455 Tw
(movement of population in this region has)Tj
T*
-0.0051 Tc
-0.0047 Tw
[(underlined the need for key staf)13.4(f to maintain a)]TJ
0 -1.3938 TD
0.0156 Tc
0.0339 Tw
(high level of vigilance on all communicable)Tj
0 -1.4031 TD
-0.0039 Tc
0.0000 Tw
(diseases.)Tj
/G1 1 Tf
14 0 0 14 153.09 269.88 Tm
1.000 0.400 0.000 0.000 k
/GS3 gs
0.0000 Tc
<008a>Tj
/TT10 1 Tf
13 0 0 13 167.25 269.88 Tm
0.0527 Tc
0.1000 Tw
(HA should review its contingency)Tj
0 -1.44 TD
-0.0057 Tc
-0.0077 Tw
(planning arrangements to ensure that )Tj
/G1 1 Tf
8 0 0 8 167.25 228 Tm
0.0000 Tc
0.0000 Tw
<0081>Tj
/TT10 1 Tf
13 0 0 13 181.41 228 Tm
-0.0049 Tc
-0.0058 Tw
(Hospitals and clusters recognise the)Tj
0 -1.4031 TD
0.0000 Tc
0.0069 Tw
(primacy of DH in managing hospital)Tj
0 -1.3938 TD
-0.0049 Tc
-0.0046 Tw
(outbreaks that threaten the health of)Tj
0 -1.4031 TD
-0.0026 Tc
0.0039 Tw
(the population)Tj
/G1 1 Tf
8 0 0 8 408.21 783.6001 Tm
0.0000 Tc
0.0000 Tw
<0081>Tj
/TT10 1 Tf
13 0 0 13 422.37 783.6001 Tm
0.0359 Tc
0.0685 Tw
(There is free flow of information)Tj
T*
0.0069 Tc
0.0192 Tw
(between hospitals and the regional)Tj
0 -1.3938 TD
-0.0091 Tc
-0.0160 Tw
[(of)18.6(fices of DH and systems to support)]TJ
0 -1.4031 TD
-0.0035 Tc
0.0019 Tw
(this are developed)Tj
/G1 1 Tf
8 0 0 8 408.21 705.84 Tm
0.0000 Tc
0.0000 Tw
<0081>Tj
/TT10 1 Tf
13 0 0 13 422.37 705.84 Tm
0.0011 Tc
0.0085 Tw
(There are clear chains of command)Tj
T*
0.0700 Tc
0.1333 Tw
(to ensure communication and)Tj
0 -1.3938 TD
-0.0033 Tc
0.0010 Tw
(implementation of HA decisions and)Tj
0 -1.4031 TD
-0.0051 Tc
-0.0054 Tw
(advice in response to an emergency)Tj
/G1 1 Tf
8 0 0 8 408.21 628.08 Tm
0.0000 Tc
0.0000 Tw
<0081>Tj
/TT10 1 Tf
13 0 0 13 422.37 628.08 Tm
0.0030 Tc
0.0128 Tw
(HA management arrangements are)Tj
T*
0.0021 Tc
0.0108 Tw
[(suf)20.6(ficiently resilient to cope with the)]TJ
0 -1.3938 TD
0.0005 Tc
0.0076 Tw
[(absence of key staf)19(f and suf)9.7(ficiently)]TJ
0 -1.4031 TD
0.0085 Tc
0.0215 Tw
(streamlined to respond rapidly to a)Tj
T*
-0.0043 Tc
0.0000 Tw
(crisis)Tj
/G1 1 Tf
8 0 0 8 408.21 532.2 Tm
0.0000 Tc
<0081>Tj
/TT10 1 Tf
13 0 0 13 422.37 532.2 Tm
-0.0127 Tc
-0.0308 Tw
(There is coordination of activities with)Tj
T*
-0.0030 Tc
0.0015 Tw
(the private sector in primary care.)Tj
/G1 1 Tf
14 0 0 14 394.05 489.84 Tm
0.0000 Tc
0.0000 Tw
<008a>Tj
/TT10 1 Tf
13 0 0 13 408.21 489.84 Tm
-0.0128 Tc
-0.0274 Tw
(HA needs to develop clarity over the role)Tj
0 -1.4308 TD
-0.0138 Tc
-0.0320 Tw
(of its own Board during the management)Tj
0 -1.4031 TD
-0.0118 Tc
-0.0235 Tw
(of an outbreak, and the role of the Board)Tj
T*
0.0111 Tc
0.0269 Tw
[(of individual hospitals. Consideration)]TJ
0 -1.3938 TD
-0.0013 Tc
0.0044 Tw
(should be given to the value of utilising)Tj
0 -1.4031 TD
0.0414 Tc
0.0785 Tw
(the experience and skills of Board)Tj
T*
0.0077 Tc
0.0213 Tw
[(members in communicating with staf)16.9(f,)]TJ
0 -1.3938 TD
-0.0028 Tc
0.0025 Tw
(patients and local populations.)Tj
/G1 1 Tf
14 0 0 14 394.05 337.92 Tm
0.0000 Tc
0.0000 Tw
<008a>Tj
/TT10 1 Tf
13 0 0 13 408.21 337.92 Tm
0.0550 Tc
0.1048 Tw
(Consideration should be given to)Tj
0 -1.44 TD
0.0007 Tc
0.0077 Tw
(changing the name of HA, for example)Tj
0 -1.3938 TD
-0.0104 Tc
-0.0218 Tw
[(to the Health Services )45(Authority)63.4(, in order)]TJ
0 -1.4031 TD
-0.0024 Tc
0.0029 Tw
(to reflect its wider responsibilities.)Tj
ET
Q
endstream
endobj
28 0 obj
<<
/ProcSet [ /PDF /Text ]
/Font << /TT6 5 0 R /TT7 6 0 R /TT8 7 0 R /TT9 8 0 R /TT10 9 0 R /G1 10 0 R >>
/ExtGState << /GS2 11 0 R /GS3 12 0 R >>
/ColorSpace << /Cs7 13 0 R >>
>>
endobj
29 1 obj
<< /Type /Metadata /Subtype /XML /Length 814 >>
stream
2003-09-28T13:48:43Z
Agfa Apogee Normalizer
2003-09-29T09:43:19+08:00
2003-09-28T13:48:43Z
2003-09-29T09:43:19+08:00
2003-09-29T09:43:19+08:00
endstream
endobj
32 0 obj
<<
/Type /FontDescriptor
/Ascent 752
/CapHeight 737
/Descent -271
/Flags 6
/FontBBox [ 0 -211 1359 899 ]
/FontName /FDCDIH+Wingdings
/ItalicAngle 0
/StemV 58
/XHeight 553
/CIDSet 33 0 R
/FontFile3 34 0 R
>>
endobj
33 0 obj
<< /Filter /FlateDecode /Length 19 >>
stream
Hbd@LlH
endstream
endobj
34 0 obj
<< /Subtype /CIDFontType0C /Length 377 >>
stream
FDCDIH+Wingdings !gOv"%$ AdobeIdentityALMDAP+Wingdings Jgg(M;g.;jIIGGk<-FLRRaq`z۬άxedYL!__aeѨnQSE:9nFQQRREn: