Malaria Myths Are Becoming a Thing of the Past “YOU are drinking again, darling!” exclaims a Pailin villager to her husband. “Aren’t you afraid of having of drug-resistant malaria on the Thai-Cambodian border a stomach ache?” “No, my dear, I feel a shiver in my backbone,” replies the man to his missus. “I am just drinking once in a Quarterly Newsletter of the Strategy for the Containment of Artemisinin-Tolerant Malaria Parasites in South-East Asia Project while lest I get malaria.” This song lyric from the 1970s is October-December 2010 just one of the many myths some Cambodians have of malaria and how WHO Implements Ambitious Project to Fight Malaria they can protect themselves. However, orking closely with the many people across the country have Wgovernments of Cambodia and other more common myths and Thailand, the World Health Organization superstitions about malaria. has developed an ambitious cross- For many Cambodians on the border malaria containment project move, going into a new cleared area in a bid to eliminate malaria resistant in the forest could mean sickness – parasites and wipe out the mosquito- not because of malaria, but due to borne disease along the border areas the belief that they have not adapted A woman farmer in Pailin appeasing the land spirits. Pix by WHO/Chhean Nariddh Moeun of two countries. to the new land and climate. Others This $22.5-million project, funded believe that drinking water from the conversation for being a place where Mr. Chheang. by the Bill & Melinda Gates Foundation, stream that flows in a ‘new land’ will people could either become rich after Another prevalent myth in Pailin uses a combination of prevention and also make them ill. Cambodians would finding gems or die of the mosquito- involved young people. “They were treatment methods that have proven call this illness “Chanh Teuk, Chanh borne disease. told by the old people to look up into to be effective against malaria. The Dei” in Khmer instead of “Krun Chanh” Therefore in the early days, many the sky when it rained, otherwise they project strategy includes large-scale or malaria. Cambodians were fearful of traveling would get malaria fever,” a malaria distribution of long-lasting insecticide- Forays into the forest also have their to the area in the west of the country. expert in Pailin says, laughing. treated mosquito nets, free early fair share of superstitions. For instance But now, myths and superstitions diagnosis and treatment of malaria if Cambodians have fever after a stint Between the 1960s and 1970s, about malaria are a thing of the past. at the village level, 24-hour health in the jungle, they would blame it on a around 15,000 mostly Kolar ethnic “Myths and superstitions about facilities to diagnose and treat malaria spell or curse cast by the forest spirits. minority people from Burma had malaria have almost disappeared,” and intensive surveillance of positive settled in Pailin, according to Mr. says Dr. Boukheng Thavrin, Chief of cases as well as other education They would call this sickness “Chanh Map showing containment zones Neakta.” Cambodia’s National programmes and innovative means to All these beliefs “The kru Khmer would warn his clients that they could Malaria Centre’s reach the mobile migrants. the health ministries of Cambodia conduct inspections aimed at make the conditions have said something wrong and made the forest spirits Health Education Early last year, WHO warned that and Thailand, and other partners, to uncovering outlets selling these drugs. contain the resistant parasites, with The Ministry of Health in Cambodia of the illness worse. unhappy. And that was the reason for their fever.” Unit. parasites resistant to artemisinin had Instead of trying to Though some emerged along the Thai-Cambodian the ultimate aim of eliminating them has trained 250 “justice police” who from the target regularly check pharmacies, shops get treated with modern medicines, Chheang, who has been a health people still believe that they could zone. and markets to try to ensure that only people give offerings and pray to the worker fighting malaria for more get sick when they go to new land Drugs based recommended malaria drugs are sold. land and forest spirits so that they are than half a century. He said the Kolars clearings or into the forest, she says on artemisinin Activities are being implemented released from a spell or curse. had moved to Cambodia to look for they still sought treatment from alone, rather than in the target zone, known as zone 1 Some people may go to a kru Khmer, gemstones that were abundant in medical doctors. Pailin during those years. “They no longer pray [to spirits] combined with that covers areas where artemisinin or traditional healer, who claims to other drugs, have tolerance has already been detected, have psychic and spiritual power that Whether or not the Kolars knew when they are sick,” she adds. anything about malaria, Mr. Chheang Dr. Thavrin believes that the been blamed for and in a much larger buffer zone, enables him to communicate with contributing to known as zone 2 where there is no says, they had a set of “do” and “don’t” education campaign launched by the ghosts or the spirits. resistance. evidence of tolerance yet, but the rules to follow to avoid getting sick. National Malaria Control Centre had Yeang Chheang, a 72-year-old Because of this, risk is also high. In Cambodia, zone 1 Rule No 1: Don’t take a bath at contributed to people’s knowledge veteran malaria worker in Pailin, the Cambodian covers about 270,000 people in four night; Rule No 2: Wear your hat when and awareness about malaria. explains. Government has provinces - all of Pailin and parts of going out at night; Rule No 3: Don’t “Now they know how malaria “The kru Khmer would warn his now banned the Battambang, Pursat and Kampot. In clients that they could have said pluck and eat ripe bananas, papayas [parasites] are transmitted,” she use of single- Thailand, about 110,000 people live in or oranges from trees. (You should eat explains. “What we are proud of [is the something wrong and made the forest Drawing a blood sample in a finger stick for the PCR tray. PCR technology drug treatments zone 1 - in the border areas of Trat and spirits unhappy. And that was the only the ripened fruits). fact that] people who had never used is highly accurate and capable of detecting minute levels of parasites. Pix for malaria. The Chanthaburi provinces. reason for their fever.” “When the Khmer newcomers got mosquito nets are now using them.” by WHO/Sonny Krishnan project has also Zone 2 in Cambodia covers nine When Cambodians talk about sick with fever, their eating habits border, posing a serious threat to made concerted provinces with a total population malaria, Pailin would be on top of their were blamed for their illness,’’ adds Chhean Nariddh Moeun global efforts to control malaria. efforts to stop the sale of fake and of more than four million, while in Artemisinin-based drugs are the most substandard drugs, which are believed Thailand zone 2 comprises seven effective treatment against malaria to be a major contributing factor provinces with a population of nearly CONTAINMENT is published by WHO Cambodia’s Malaria Containment Project. For enquiries please and have made huge strides over the to the development of resistance. seven million, about 150,000 of whom contact Dr. Najibullah Habib, Malaria Containment Project Manager, World Health Organization past decade in controlling the disease. Through the project, drug inspectors are living in malaria risk areas. Cambodia, 177-179 St. Pasteur (51), PO Box 1217, Phnom Penh OR e-mail: [email protected] WHO has been working closely with have been trained, and now regularly continued on page 2 Fighting Counterfeit Anti-Malarials What are the efforts to eliminate these A Force of Dedication in the Field counterfeit and substandard drugs An interview with Dr. Doung have deployed our people along the incidence of malaria by about under the same regional office based sold by the private sector and also Socheat, Director National Center for Cambodian-Thai border. We have also 50 per cent, I would say,... in Chon Buri, where Ms. Uraiwan enforce the ban on oral artemisinin Parasitology, Entomology and Malaria made big efforts to distribute long- through all activities.” graduated from Burapha University in monotheraphy? Control. lasting insecticide-treated nets (LLINs) The Fixed Schedule Malaria public health. to people in the area. We are also Clinics, which are placed right Difficulties in Cambodia, especially We provide regular monthly trainings making concerted efforts to control on the border with Cambodia, along the border with Thailand to all companies involved in the the sale, by retail outlets and in the “enables us to draw blood compromised Cambodia’s malaria import and export of pharmaceutical markets, of counterfeit and substandard samples and verify quickly control efforts for many years. products. We have also communicated anti-malarials in the targeted area that through microscopy if they to all pharmacies and drug-sellers we call Zone 1. Besides that we are are positively carrying malaria However, having been trained in of the Ministry of Health’s ban on also doing mass screening of children, parasites”. By quickly, she public health, Ms. Uraiwan knows women and men in Zone 1 to diagnose monotheraphies. It is important to and treat malaria. Our aim is to contain inform the drug-sellers first, before we do When Uraiwan Tattong speaks, you have to listen, and eliminate artemisinin-resistant law enforcement with the Justice Police not only because of what she as to say, but because falciparum malaria in Zone 1. who go around inspecting pharmacies her voice has a warmth of tone and quality of texture The results have been very and other drug retail outlets. The drug- encouraging. It is an indication that our sellers have to be made aware of the that would make her a contralto if she were to take up containment strategy is working in the dangers and the harm they could cause singing. high transmission areas. Let me give you with the sale of fake anti-malarials and means 20 minutes. that issues verging on life and death an example. Previously when we first monotheraphies. In this province, these transcend all others, and, through Dr. Doung Socheat, in a quest to eliminate We raise this awareness by constantly falciparum malaria in Cambodia. Pix by WHO/ started mass screening of about 3,000 clinics happen twice a week her work, has tried hard to build trust putting out Information, Education and Sonny Krishnan people we found over 100 positive at three points on the border among nationals of both countries, no falciparum malaria cases. Recently we Communication (IEC) materials, which and began operating since matter what is happening on other There is evidence of artemisinin- did screening of the same size of people are distributed to communities, warning Uraiwan plays a big role in curbing vector-borne diseases in March 2009. fronts. resistant malaria in Western Cambodia, and only found eight positive cases. This of the dangers of monotheraphies and eastern Thailand. Pix by WHO/Anuraj Manibhandu At 54, Ms. Uraiwan has particularly along the Cambodian-Thai drop in the number of positive cases the dangers of buying fake drugs. These Sa Kaeo, Eastern Thailand -- This played a responsible role in curbing border. What efforts are being made is very significant. In 2009, we had no IECs also inform the public that the lady responsible for the province’s vector-borne diseases in this part of to reduce the morbidity and mortality deaths due to falciparum malaria in the government has banned the marketing malaria control activities shows eastern Thailand for some years. She rates there? area, especially in Pailin. and sale of “single-drug” artemisinin dedication and know-how, going out became head of the centre that deals malaria medicines, in order to prevent into the sun to check out a mobile malaria and other diseases carried by We have been working with different Counterfeit and substandard anti- malaria parasites from developing clinic, and presenting power points to mosquitoes here in Sa Kaeo in October partners, especially with WHO, with malarials are one of the causes for the resistance to this drug. a room full of experts pressing her to 2009, after serving in the same position funding from the Global Fund. We emergence of MDR-falciparum malaria. continued on page 3 say more. in Si Racha, further southwest, for two When Uraiwan Tattong speaks, years. ....from page 1 you have to listen, not only because She hesitated to admit that coming Cambodia is making dramatic of what she has to say, but because here was something of a promotion, progress. As of 14 September her voice has a warmth of tone and but she did say that the seaside town 2010, there were only two cases quality of texture that would make of Si Racha, on the Gulf of Thailand, of falciparium malaria from 5,686 her a contralto if she were to take up “is smaller than Sa Kaeo.” Asked what people screened in 16 villages in singing. her sights were in the six years she has Pailin, which previously were the She affirms that the project to left before the mandatory retirement most affected in the border area. contain killer malaria parasites tolerant age of 60, she replied “that’s up to my In the adjacent area in Thailand to artemisinin has had a positive higher-ups.” A mobile clinic along the Thai-Cambodian -- Soi Dao and Pong Nam Ron impact here. “It has helped reduce the Both Sa Kaeo and Si Racha come border. Pix by WHO/Anuraj Manibhandu districts of Chantaburi province -- there was a similar trend, with ....from page 6 “Back then, it was all forests and After he retired from the incidence of falciparum malaria The Khmer Rouge also needed him we couldn’t see the mountains. government’s Malaria Control Centre dropping from sixteen (16) to to fight malaria. Mr. Chheang said the Wild animals were everywhere,” Mr. 15 years ago, Mr. Chheang was seven (7) from 2008 to 2009, Khmer Rouge used herbal and other Chheang said, pointing at deforested hired by WHO to help with malaria the year before the cross-border traditional medicines instead of the mountains in the distance. containment work in the fields. project kicked in and the year modern medication to treat malaria But, it was not only the landscape With almost continuous work after. and other illnesses. that was different. Mr. Chheang to fight malaria for more than half So far, more than half a million Now at the age of 72, Mr. Chheang said they also had far less advanced a century, Mr. Chheang said he still bed-nets have been distributed, is still working in the field in a new facilities to do the work. enjoys doing his job. including more than 260,000 in about 2,900 volunteer village malaria works to undermine the sale of fake and mission led jointly by the Cambodian He said that there was no telephone “I am happy with the work; I am zone 1. A further 200,000 existing workers, or VMWs, in Cambodia and sub-standard anti-malarial drugs from government and WHO, together with in the district and that people had to happy in the village,” he said recently, mosquito nets have been treated with 326 in Thailand. These VMWs are fully the private sector where Cambodians its partners, to contain artemisinin- go to the post office to send mails via with a smile before gesturing at a insecticide. This distribution means trained and equipped to diagnose have usually sought treatment. In both resistant malaria parasites which telegraphs. mother and daughter to go for blood that all villagers in zone 1 and all malaria in the village using a rapid Cambodia and Thailand, treatment for have emerged in the areas along the “Now, people are much more screening for malaria in Pailin’s O Ro’El people in the high-risk villages in zone diagnostic test and to provide the malaria is now available 24-hours a Cambodian-Thai border. sophisticated; they have computers; village. 2 are able to sleep under a mosquito patients with the appropriate drugs day through public health centres and Looking back to more than half they use emails,” he said, adding: Chhean Nariddh Moeun net each night. for free. This strategy – providing free VMWs. a century ago, he said things have “Now, we have a large team that can Meanwhile, the project has trained anti-malarial drugs in the village – also changed a lot. cover all high-risk areas.” 2 7 Malaria Champion: Yeang Chheang ‘We Want to Work Closely with the Cambodians’ Interview with Dr Wichai Satimai, Thailand’s national agenda, which is applies to Thailand’s co-operation with A Life Dedicated to Fighting Malaria Director, Bureau of Vector-Borne evident in the Bureau of Vector-Borne Cambodia and other neighbours. It was 1962 when Mr. Yeang the outbreak despite meager Diseases, Thailand. Disease’s partnership in the project, Chheang, then a 24-year-old malaria resources and few local how do you think the question of The principle is we would like to work specialist, was on a mission to experts. malaria control should be raised? closely with Cambodia. Unfortunately, Cambodia’s southwest coastal town Working as an entomologist there is a language problem between of Sihanoukville, when he was called technician at the Ministry of The malaria situation in Thailand Thais and Cambodians that needs to back to the capital. Health’s Malaria Eradication is better than before with incidence be improved. This affects containment, He was re-assigned to carry out Department, Mr. Chheang said down from about 100,000 say ten because we cannot do follow-up work yet another greater mission to the he was sent to Manila to study years ago to about 25,000 now, among on people who cross the border after northwestern tip of the country on the about malaria in 1960 when he Thais and non-Thais. However, with 28 days. border with Thailand. He was sent to was 23 years old. the emergence of new epidemics such With other countries who share Pailin, where a malaria outbreak was During his mission to contain as SARS, or H1N1, non-communicable borders with Thailand, for example devastating the lives of hundreds of malaria outbreak in Pailin almost diseases and illnesses deriving from with Malaysia, and Laos, we do not people from all walks of life. fifty years ago, Mr. Chheang Yeang Chheang - answered the call to save lives. Pix by environmental and chemical causes, have as much of a language problem. Mr. Chheang was tasked to contain said his biggest challenge was WHO/Chhean Nariddh Moeun the human resources and budget have With Myanmar, many of their nationals this outbreak. So, without delay, he to communicate with WHO’s Italian Like many health workers, Mr. to be shared. cross the border because they accept set off to Pailin. team leader who preferred to speak Chheang said he saw his work changing With regard to containment of and know our facilities, and appreciate He recalled that during this English instead of French – the completely – from fighting malaria to artemisinin-resistance, we would like that these are free of charge, including outbreak, between 20 and 30 Pailin foreign language spoken by Khmer fighting the Khmer Rouge rebels. Mr. people in Thailand and other countries long-lasting insecticide-treated nets. residents died from Chheang was promoted around the world to know that this It’s a push and pull situation. malaria everyday. Unlike most medical practitioners and other to the rank of a military Dr Wichai Satimai, Director Bureau of Vector- is similar to resistance to Fansidar I agree totally with the WHO Borne Diseases, Thailand. Pix by BVBD, Thailand “So many people were intellectuals who were targeted and killed commander in Siem Reap. (sulfadoxine-pyrimethamine), which secretary general. We cannot stand dying that the crematorium “I was carrying guns Please identify one benefit Thailand also spread. It means we have to alone. Thailand has to work with overflowed [as it exceeded by the Khmer Rouge, Mr. Chheang’s life was instead of syringes,” he has enjoyed from the project, mainly ask specialists from international nearby countries. its capacity to cremate spared with a stroke of luck. The Khmer said, raising his hands in a supported by the Bill & Melinda organizations to help us. Hence we Today (Sept 1), the Department too many bodies],” he Rouge also needed him to fight malaria. shooting gesture. He added: Gates Foundation, to contain and have to co-operate with the World of Disease Control is meeting with remembered. “I always slept in the trench, eliminate malaria parasites tolerant Health Organization, the Bill & Myanmar, whose officers have come Under this mission, he said the intellectuals. [while] we were on guard to prevent to artemisinin in Southeast Asia. Melinda Gates Foundation, the Global to discuss co-operation in tuberculosis Malaria Eradication Department of But, it was an advantage, though, the Khmer Rouge.” Fund. At the Global Fund’s Round 7, and malaria. For nearly nine years, we Cambodia’s Ministry of Health had he said. However, Mr. Chheang said he The support Thailand has received two research groups participated. have our shared our experiences. We mobilized a 20-member-strong team Over the years, Mr. Chheang said he was taken back to work on another in particular from the Bill & Melinda We are asking Global Fund Round have other channels to work together that included four village malaria taught French to his Italian colleague malaria prevention program in Siem Gates Foundation has helped boost 10 to include 12 non-governmental with neighbours. This includes the workers, or VMWs. while learning English from him till Reap province after about a year in human resources and equipment. organisations that work with us as capacity-building programme for the Mr. Chheang remembered that they could understand each other well the army till the Khmer Rouge came to With more full time and part-time staff recipients. We need their experience in Mekong Region countries supported an Italian doctor named L. Cervone in both languages. power in 1975. here at the Bureau of Vector Borne working with migrants. We realise that by the USAID and the ADMECs from the World Health Organization’s Less than ten years later, another Unlike most medical practitioners Diseases, and in the border areas, patients, nearly half of them migrants (Ayewaddy-Chaophraya-Mekong Malaria Control Project, which was catastrophe broke out, but not malaria. and other intellectuals who were including translators at malaria clinics moving from nearby countries, are Economic Co-operation Strategy), established in Cambodia in 1955, led The civil war started following the targeted and killed by the Khmer and IT people, and the equipment we undocumented and may be afraid of whose health officers met in Thailand the team. overthrow of then-Prince Norodom Rouge, Mr. Chheang’s life was spared need for containment activities – such the government. Aug 26-27 to fine-tune activities. All of With the intensive work, he Sihanouk’s government that paved with a stroke of luck. as motorcycles (42), good microscopes these come to the same direction: to reckoned that it took the team seven the way for the first Khmer Republic of (40), and pickup trucks (seven which The secretary-general of the reduce our burden of diseases. months before they could contain Marshall Lon Nol. continued on page 7 replaced 20-year-old ones) – we have World Health Organization has made made much progress. clear that health issues transcend all ....from page 5 mechanism for sharing information The success of the DTMM module Since malaria control remains on borders. Please reflect on how this and technical support could reach all first and foremost. Moreover, the in Thailand’s Saiyok District of the data entry sites. mechanism should clearly define the Kanchanaburi was “a big chance to ....from page 2 programme with WHO. Ten years ago was able to provide some form of health roles of each country representative prove that informatics (using mobile our health structures were still weak service. But now things have changed. “Most of the challenges we face acting as the focal point, Mr Amnat technology) could be an effective The previously high use of artemi- because we lacked human resources at The government has committed more now are human resources and co- said. It must be clear who will be doing management tool to eliminate sinin in Cambodia consisted of mono- the grassroots level. Even our in-country funds for health infrastructure. Health ordination across different levels,” he what, when, where, and why with the drug-resistant malaria,” he said. therapies provided through the private health infrastructure was not strong facilities have improved and there are noted. information that is generated. Features awaiting development and sector. In 2008 the government banned enough. We did not have proper roads; more incentives now for public health incorporation into this system include: monotherapies with the Justice Police, we did not have health facilities in the workers. International donors have In the DTMM module, information Collaboration on case investigations real-time monitoring and reporting as you said earlier, enforcing the ban. remote areas. So we cannot blame supported us in improving our health can be captured on the phone in will be possible after messages or of infected cases, microscopic The 2009 ACT Watch Outlet Survey people, at that time, for going to the infrastructure. areas without a telephone signal, reports are received. Then the health digitizing imaging, the capturing of Report for Cambodia found that only 8 private sector because the public sector We have created more access to the and malaria-control staff can later information system of both countries follow-up locations with infections percent of malaria treatments from the did not have enough capacity. Also during health facilities, now, for the people. And synchronize information onto a malaria can be used to support any activities by using a mobile phone panel, and private sector were artemisinin mono- that time people in the public sector there is a concerted effort to encourage clinic or wherever a signal is available created from this co-operation. disease mapping with a geographical therapies. Unlike previous years, this is were very poorly paid, and so there them to use government facilities, rather Collaboration in information “and information system or GIS. a great reduction. Can you comment on was not much commitment to provide than to go to the private sector. We are If the DTMM module was to be action” were vital for driving this Anuraj Manibhandu this positive development? services. So sick people just flocked to also engaging the private sector to refer used for cross-border surveillance cross-border mechanism successfully, the private sector. Even if you went to malaria cases to the government health of malaria cases, there should be a he stressed. This is a key issue in our containment the villages, the smallest drug retailer centers. 6 3 Village Malaria Workers: ‘The Foot Soldiers’ in Malaria Fight Malaria Surveillance Using Mobile Phone Technology skills and to help people avoid getting But after recog- sick, particularly the migrant laborers nising the “long term she hired to work on her farm. value” for surveillance “We gave them mosquito nets and and reporting in the educated them about malaria,” she DTMM module that says when the laborers return to Pailin the Bill & Melinda during the corn harvest twice a year. Gates Foundation fully Like Rin Tith and Top Malay, 39- supported in two high- year-old Long Vuthy from Pailin’s risk districts -- Pong Phnom Dambang village, says he Nam Ron and Borai, decided to be a VMW to help reduce respectively located malaria deaths and illness. in the provinces of “I think this village is far from the Chantaburi and Trat -- Health Center and the hospital [so it the bureau decided to needs a VMW],” he says, pointing his finance expansion of finger into the distance. it to other vulnerable Many villagers say they welcome pockets along the A village malaria worker in Pailin province takes a blood sample from two young men to test for the idea of having VMWs to treat eastern border out of malaria. Pix by WHO/Harri Anenden malaria. its own budget. It was, The diagnosis begins: “What’s your including 86 villagers in Pailin. “It’s good that we have VMWs Besides supporting mobile phone technology, the DTMM module also allows web-based tracking of malaria in Dr Wichai’s words, “an patients. Pix by Google Earth name?” These “foot soldiers,” as an expert nearby in case we are sick at night,” opportunity to strengthen “Yeath Mab.” puts it, received a three-day training explains Kim Sary, a 53-year-old farmer THE explosive spread of mobile The DTMM module enables remote our surveillance system and reporting “How long have you been sick?” to do the diagnosis, the test and the in Andong Phi village. “Their drugs phone networks across the data transfer in both textual and as well.” “Three days.” treatment in their villages for farmers are very effective if you take them developing world has created a unique geographic format allowing details “Did you ever have malaria and other people. properly.” opportunity to significantly transform of registered patients, who visit the A major problem in the bureau’s before?” To target the mobile workers, CNM Korn Huoth, a 32-year-old farmer how countries can tackle global health malaria clinic, and their treatment vertical control programme is that it “Yes, five years ago.” has trained more than a hundred in Phnom Dambang village, agrees. challenges, including the containment history to be examined. Responsible may not be accessible to people living “How do you feel now?” Migrant Malaria Workers, or MMW’s, “VMWs have done a good job of drug-resistant malaria along the malaria staff at the local treatment in remote communities, and to people- “I have a fever and I feel a shiver in who were chosen among the migrant [and] are friendly with the villagers,” Thai-Cambodian border. sites are provided with mobile phones on-the-move who are undocumented my body.” workers themselves. he says. migrants from neighbouring The blood test begins. Upon completion of the training, The strategy of deploying VMWs The Disease and Using the Biophics-designed DTMM module countries and hence afraid of “Wait 15 minutes!” each VMW was provided with a bicycle, in malaria infested areas has proven Treatment Monitoring authorities. Dr Wichai said to be a success in combating malaria, we will know the name (of the patient), the One, two, three, four, five... 15 a pair of boots, a bag, a flashlight, a of Malaria (DTMM) kind of malaria and the follow-up thatneeds he had asked the Global Fund minutes have passed. raincoat and a cooler box to keep says Dr. Po Ly, Cambodian National module, a part of Against Aids, Tuberculosis and “You have no malaria.” medicines plus a monthly transport Malaria Centre’s VMWs Project Team the Better Border to be done at every level – from the district Malaria, Round 10, for 12 non- To a stranger, Rin Tith, a 30-year- allowance. Leader. Healthcare Program to the provincial and central levels… governmental organisations old father from Angdong Phi village in But, it’s usually personal stories “We’ve seen good results that created by the Centre to become grant recipients Cambodia’s Pailin province, looks like a and experience that motivate villagers there’ve been less malaria cases now,” of Excellence for Biomedical and loaded with the follow-up application; because they had experience working professional physician the way he does to become voluntary VMWs. he says. “It’s a good strategy to reduce Public Health Informatics at Mahidol they use the case-follow-up function with migrants. the diagnosis, the test and treatment. Rin Tith says that he himself has malaria deaths and malaria resistant University or Biophics, uses mobile of the DTMM to update the follow- But he is no medical doctor. been sick with malaria 20 times since [parasites].” and web-based technology to alter up status on the schedule date, and Asked about challenges in He is just a Malaria Education he moved to Pailin nine years ago. So, However, Dr. Po Ly says the treatment-seeking behaviours and capture the locations (GPS coordinates) introducing the DTMM module along Village Volunteer, better known as he says he immediately took the offer success should also be attributed to facilitate better treatment and care each time local malaria staff perform the Thai-Cambodian border, Amnat Village Malaria Worker or VMW, who when he was asked to be a VMW a few the cooperation from the Ministry of for malaria patients in low-resource routine home visits. Khamsiriwatchara, deputy director has been trained to do the diagnosis, years ago. His main purpose is to help Health and local authorities. settings. It has speeded up detection of Biophics, said infrastructure and the test and treatment for malaria at fight malaria. Dr. Po Ly says he is pleased that at the point-of-care, made reporting This replaces paper-based case- computer facilities to connect with the village level. This project is part Top Malay, a 22-year-old farm the villagers trust VMWs despite their to decision-makers close to real time, tracking in the villages, and supersedes the system were “not a big problem”. of Cambodia’s malaria containment owner in Pailin’s Suon Ampov Keut reluctance at the start of the project. and improved the accuracy of mapping routine map-drawing for case locations. He pointed out that network coverage efforts spearheaded by the World village, says she decided to become a “At the beginning, people didn’t malaria risk locations. The DTMM also sends home-visit- continued on page 6 Health Organization and implemented VMW because she wanted to learn the believe them as they had been trained schedule reminder messages directly by the Cambodian National Malaria only a few days,” he says. “Now, people “We can use IT [Information to responsible Centre. believe them after they had effectively Technology] to help us fill in data in local staff. Rin Tith continues. He tells the sick treated [many] patients.” real time and send it to Biophics,” migrant worker that his illness is just a Dr. Po Ly says the villagers have said Dr Wichai Satimai, director of the Dr Wichai said normal fever. Then, he gives him a few many other advantages of having Bureau of Vector-Borne Diseases, of officials down fever pills and reminds him to sleep VMWs. the usefulness of the system. “Then the line had been in a mosquito net to avoid getting “It helps reduce poverty when they using the Biophics-designed DTMM “happy” with the malaria. don’t have to pay for their treatment module we will know the name (of paper system The patient returns home. which is free of charge,” he explains. the patient), the kind of malaria and of registry and Under its ambitious containment He adds that the villagers can do the follow-up that needs to be done follow-up still A sign, in Pailin’s Pich Kiri Village, showing the strategy, the Cambodian National more work and make more money at every level – from the district to existing in low- times when the VMW is available. There is when they are not sick. risk areas. Malaria Center (CNM) has trained an after-hours mobile contact number. Pix by the provincial and central levels,” he almost 3,000 VMW’s nationwide, WHO/ Sonny Krishnan Chhean Nariddh Moeun added. Screen shots of case follow-up on mobile phone. Pix by Biophics 4 5 Village Malaria Workers: ‘The Foot Soldiers’ in Malaria Fight Malaria Surveillance Using Mobile Phone Technology skills and to help people avoid getting But after recog- sick, particularly the migrant laborers nising the “long term she hired to work on her farm. value” for surveillance “We gave them mosquito nets and and reporting in the educated them about malaria,” she DTMM module that says when the laborers return to Pailin the Bill & Melinda during the corn harvest twice a year. Gates Foundation fully Like Rin Tith and Top Malay, 39- supported in two high- year-old Long Vuthy from Pailin’s risk districts -- Pong Phnom Dambang village, says he Nam Ron and Borai, decided to be a VMW to help reduce respectively located malaria deaths and illness. in the provinces of “I think this village is far from the Chantaburi and Trat -- Health Center and the hospital [so it the bureau decided to needs a VMW],” he says, pointing his finance expansion of finger into the distance. it to other vulnerable Many villagers say they welcome pockets along the A village malaria worker in Pailin province takes a blood sample from two young men to test for the idea of having VMWs to treat eastern border out of malaria. Pix by WHO/Harri Anenden malaria. its own budget. It was, The diagnosis begins: “What’s your including 86 villagers in Pailin. “It’s good that we have VMWs Besides supporting mobile phone technology, the DTMM module also allows web-based tracking of malaria in Dr Wichai’s words, “an patients. Pix by Google Earth name?” These “foot soldiers,” as an expert nearby in case we are sick at night,” opportunity to strengthen “Yeath Mab.” puts it, received a three-day training explains Kim Sary, a 53-year-old farmer THE explosive spread of mobile The DTMM module enables remote our surveillance system and reporting “How long have you been sick?” to do the diagnosis, the test and the in Andong Phi village. “Their drugs phone networks across the data transfer in both textual and as well.” “Three days.” treatment in their villages for farmers are very effective if you take them developing world has created a unique geographic format allowing details “Did you ever have malaria and other people. properly.” opportunity to significantly transform of registered patients, who visit the A major problem in the bureau’s before?” To target the mobile workers, CNM Korn Huoth, a 32-year-old farmer how countries can tackle global health malaria clinic, and their treatment vertical control programme is that it “Yes, five years ago.” has trained more than a hundred in Phnom Dambang village, agrees. challenges, including the containment history to be examined. Responsible may not be accessible to people living “How do you feel now?” Migrant Malaria Workers, or MMW’s, “VMWs have done a good job of drug-resistant malaria along the malaria staff at the local treatment in remote communities, and to people- “I have a fever and I feel a shiver in who were chosen among the migrant [and] are friendly with the villagers,” Thai-Cambodian border. sites are provided with mobile phones on-the-move who are undocumented my body.” workers themselves. he says. migrants from neighbouring The blood test begins. Upon completion of the training, The strategy of deploying VMWs The Disease and Using the Biophics-designed DTMM module countries and hence afraid of “Wait 15 minutes!” each VMW was provided with a bicycle, in malaria infested areas has proven Treatment Monitoring authorities. Dr Wichai said to be a success in combating malaria, we will know the name (of the patient), the One, two, three, four, five... 15 a pair of boots, a bag, a flashlight, a of Malaria (DTMM) kind of malaria and the follow-up thatneeds he had asked the Global Fund minutes have passed. raincoat and a cooler box to keep says Dr. Po Ly, Cambodian National module, a part of Against Aids, Tuberculosis and “You have no malaria.” medicines plus a monthly transport Malaria Centre’s VMWs Project Team the Better Border to be done at every level – from the district Malaria, Round 10, for 12 non- To a stranger, Rin Tith, a 30-year- allowance. Leader. Healthcare Program to the provincial and central levels… governmental organisations old father from Angdong Phi village in But, it’s usually personal stories “We’ve seen good results that created by the Centre to become grant recipients Cambodia’s Pailin province, looks like a and experience that motivate villagers there’ve been less malaria cases now,” of Excellence for Biomedical and loaded with the follow-up application; because they had experience working professional physician the way he does to become voluntary VMWs. he says. “It’s a good strategy to reduce Public Health Informatics at Mahidol they use the case-follow-up function with migrants. the diagnosis, the test and treatment. Rin Tith says that he himself has malaria deaths and malaria resistant University or Biophics, uses mobile of the DTMM to update the follow- But he is no medical doctor. been sick with malaria 20 times since [parasites].” and web-based technology to alter up status on the schedule date, and Asked about challenges in He is just a Malaria Education he moved to Pailin nine years ago. So, However, Dr. Po Ly says the treatment-seeking behaviours and capture the locations (GPS coordinates) introducing the DTMM module along Village Volunteer, better known as he says he immediately took the offer success should also be attributed to facilitate better treatment and care each time local malaria staff perform the Thai-Cambodian border, Amnat Village Malaria Worker or VMW, who when he was asked to be a VMW a few the cooperation from the Ministry of for malaria patients in low-resource routine home visits. Khamsiriwatchara, deputy director has been trained to do the diagnosis, years ago. His main purpose is to help Health and local authorities. settings. It has speeded up detection of Biophics, said infrastructure and the test and treatment for malaria at fight malaria. Dr. Po Ly says he is pleased that at the point-of-care, made reporting This replaces paper-based case- computer facilities to connect with the village level. This project is part Top Malay, a 22-year-old farm the villagers trust VMWs despite their to decision-makers close to real time, tracking in the villages, and supersedes the system were “not a big problem”. of Cambodia’s malaria containment owner in Pailin’s Suon Ampov Keut reluctance at the start of the project. and improved the accuracy of mapping routine map-drawing for case locations. He pointed out that network coverage efforts spearheaded by the World village, says she decided to become a “At the beginning, people didn’t malaria risk locations. The DTMM also sends home-visit- continued on page 6 Health Organization and implemented VMW because she wanted to learn the believe them as they had been trained schedule reminder messages directly by the Cambodian National Malaria only a few days,” he says. “Now, people “We can use IT [Information to responsible Centre. believe them after they had effectively Technology] to help us fill in data in local staff. Rin Tith continues. He tells the sick treated [many] patients.” real time and send it to Biophics,” migrant worker that his illness is just a Dr. Po Ly says the villagers have said Dr Wichai Satimai, director of the Dr Wichai said normal fever. Then, he gives him a few many other advantages of having Bureau of Vector-Borne Diseases, of officials down fever pills and reminds him to sleep VMWs. the usefulness of the system. “Then the line had been in a mosquito net to avoid getting “It helps reduce poverty when they using the Biophics-designed DTMM “happy” with the malaria. don’t have to pay for their treatment module we will know the name (of paper system The patient returns home. which is free of charge,” he explains. the patient), the kind of malaria and of registry and Under its ambitious containment He adds that the villagers can do the follow-up that needs to be done follow-up still A sign, in Pailin’s Pich Kiri Village, showing the strategy, the Cambodian National more work and make more money at every level – from the district to existing in low- times when the VMW is available. There is when they are not sick. risk areas. Malaria Center (CNM) has trained an after-hours mobile contact number. Pix by the provincial and central levels,” he almost 3,000 VMW’s nationwide, WHO/ Sonny Krishnan Chhean Nariddh Moeun added. Screen shots of case follow-up on mobile phone. Pix by Biophics 4 5 Malaria Champion: Yeang Chheang ‘We Want to Work Closely with the Cambodians’ Interview with Dr Wichai Satimai, Thailand’s national agenda, which is applies to Thailand’s co-operation with A Life Dedicated to Fighting Malaria Director, Bureau of Vector-Borne evident in the Bureau of Vector-Borne Cambodia and other neighbours. It was 1962 when Mr. Yeang the outbreak despite meager Diseases, Thailand. Disease’s partnership in the project, Chheang, then a 24-year-old malaria resources and few local how do you think the question of The principle is we would like to work specialist, was on a mission to experts. malaria control should be raised? closely with Cambodia. Unfortunately, Cambodia’s southwest coastal town Working as an entomologist there is a language problem between of Sihanoukville, when he was called technician at the Ministry of The malaria situation in Thailand Thais and Cambodians that needs to back to the capital. Health’s Malaria Eradication is better than before with incidence be improved. This affects containment, He was re-assigned to carry out Department, Mr. Chheang said down from about 100,000 say ten because we cannot do follow-up work yet another greater mission to the he was sent to Manila to study years ago to about 25,000 now, among on people who cross the border after northwestern tip of the country on the about malaria in 1960 when he Thais and non-Thais. However, with 28 days. border with Thailand. He was sent to was 23 years old. the emergence of new epidemics such With other countries who share Pailin, where a malaria outbreak was During his mission to contain as SARS, or H1N1, non-communicable borders with Thailand, for example devastating the lives of hundreds of malaria outbreak in Pailin almost diseases and illnesses deriving from with Malaysia, and Laos, we do not people from all walks of life. fifty years ago, Mr. Chheang Yeang Chheang - answered the call to save lives. Pix by environmental and chemical causes, have as much of a language problem. Mr. Chheang was tasked to contain said his biggest challenge was WHO/Chhean Nariddh Moeun the human resources and budget have With Myanmar, many of their nationals this outbreak. So, without delay, he to communicate with WHO’s Italian Like many health workers, Mr. to be shared. cross the border because they accept set off to Pailin. team leader who preferred to speak Chheang said he saw his work changing With regard to containment of and know our facilities, and appreciate He recalled that during this English instead of French – the completely – from fighting malaria to artemisinin-resistance, we would like that these are free of charge, including outbreak, between 20 and 30 Pailin foreign language spoken by Khmer fighting the Khmer Rouge rebels. Mr. people in Thailand and other countries long-lasting insecticide-treated nets. residents died from Chheang was promoted around the world to know that this It’s a push and pull situation. malaria everyday. Unlike most medical practitioners and other to the rank of a military Dr Wichai Satimai, Director Bureau of Vector- is similar to resistance to Fansidar I agree totally with the WHO Borne Diseases, Thailand. Pix by BVBD, Thailand “So many people were intellectuals who were targeted and killed commander in Siem Reap. (sulfadoxine-pyrimethamine), which secretary general. We cannot stand dying that the crematorium “I was carrying guns Please identify one benefit Thailand also spread. It means we have to alone. Thailand has to work with overflowed [as it exceeded by the Khmer Rouge, Mr. Chheang’s life was instead of syringes,” he has enjoyed from the project, mainly ask specialists from international nearby countries. its capacity to cremate spared with a stroke of luck. The Khmer said, raising his hands in a supported by the Bill & Melinda organizations to help us. Hence we Today (Sept 1), the Department too many bodies],” he Rouge also needed him to fight malaria. shooting gesture. He added: Gates Foundation, to contain and have to co-operate with the World of Disease Control is meeting with remembered. “I always slept in the trench, eliminate malaria parasites tolerant Health Organization, the Bill & Myanmar, whose officers have come Under this mission, he said the intellectuals. [while] we were on guard to prevent to artemisinin in Southeast Asia. Melinda Gates Foundation, the Global to discuss co-operation in tuberculosis Malaria Eradication Department of But, it was an advantage, though, the Khmer Rouge.” Fund. At the Global Fund’s Round 7, and malaria. For nearly nine years, we Cambodia’s Ministry of Health had he said. However, Mr. Chheang said he The support Thailand has received two research groups participated. have our shared our experiences. We mobilized a 20-member-strong team Over the years, Mr. Chheang said he was taken back to work on another in particular from the Bill & Melinda We are asking Global Fund Round have other channels to work together that included four village malaria taught French to his Italian colleague malaria prevention program in Siem Gates Foundation has helped boost 10 to include 12 non-governmental with neighbours. This includes the workers, or VMWs. while learning English from him till Reap province after about a year in human resources and equipment. organisations that work with us as capacity-building programme for the Mr. Chheang remembered that they could understand each other well the army till the Khmer Rouge came to With more full time and part-time staff recipients. We need their experience in Mekong Region countries supported an Italian doctor named L. Cervone in both languages. power in 1975. here at the Bureau of Vector Borne working with migrants. We realise that by the USAID and the ADMECs from the World Health Organization’s Less than ten years later, another Unlike most medical practitioners Diseases, and in the border areas, patients, nearly half of them migrants (Ayewaddy-Chaophraya-Mekong Malaria Control Project, which was catastrophe broke out, but not malaria. and other intellectuals who were including translators at malaria clinics moving from nearby countries, are Economic Co-operation Strategy), established in Cambodia in 1955, led The civil war started following the targeted and killed by the Khmer and IT people, and the equipment we undocumented and may be afraid of whose health officers met in Thailand the team. overthrow of then-Prince Norodom Rouge, Mr. Chheang’s life was spared need for containment activities – such the government. Aug 26-27 to fine-tune activities. All of With the intensive work, he Sihanouk’s government that paved with a stroke of luck. as motorcycles (42), good microscopes these come to the same direction: to reckoned that it took the team seven the way for the first Khmer Republic of (40), and pickup trucks (seven which The secretary-general of the reduce our burden of diseases. months before they could contain Marshall Lon Nol. continued on page 7 replaced 20-year-old ones) – we have World Health Organization has made made much progress. clear that health issues transcend all ....from page 5 mechanism for sharing information The success of the DTMM module Since malaria control remains on borders. Please reflect on how this and technical support could reach all first and foremost. Moreover, the in Thailand’s Saiyok District of the data entry sites. mechanism should clearly define the Kanchanaburi was “a big chance to ....from page 2 programme with WHO. Ten years ago was able to provide some form of health roles of each country representative prove that informatics (using mobile our health structures were still weak service. But now things have changed. “Most of the challenges we face acting as the focal point, Mr Amnat technology) could be an effective The previously high use of artemi- because we lacked human resources at The government has committed more now are human resources and co- said. It must be clear who will be doing management tool to eliminate sinin in Cambodia consisted of mono- the grassroots level. Even our in-country funds for health infrastructure. Health ordination across different levels,” he what, when, where, and why with the drug-resistant malaria,” he said. therapies provided through the private health infrastructure was not strong facilities have improved and there are noted. information that is generated. Features awaiting development and sector. In 2008 the government banned enough. We did not have proper roads; more incentives now for public health incorporation into this system include: monotherapies with the Justice Police, we did not have health facilities in the workers. International donors have In the DTMM module, information Collaboration on case investigations real-time monitoring and reporting as you said earlier, enforcing the ban. remote areas. So we cannot blame supported us in improving our health can be captured on the phone in will be possible after messages or of infected cases, microscopic The 2009 ACT Watch Outlet Survey people, at that time, for going to the infrastructure. areas without a telephone signal, reports are received. Then the health digitizing imaging, the capturing of Report for Cambodia found that only 8 private sector because the public sector We have created more access to the and malaria-control staff can later information system of both countries follow-up locations with infections percent of malaria treatments from the did not have enough capacity. Also during health facilities, now, for the people. And synchronize information onto a malaria can be used to support any activities by using a mobile phone panel, and private sector were artemisinin mono- that time people in the public sector there is a concerted effort to encourage clinic or wherever a signal is available created from this co-operation. disease mapping with a geographical therapies. Unlike previous years, this is were very poorly paid, and so there them to use government facilities, rather Collaboration in information “and information system or GIS. a great reduction. Can you comment on was not much commitment to provide than to go to the private sector. We are If the DTMM module was to be action” were vital for driving this Anuraj Manibhandu this positive development? services. So sick people just flocked to also engaging the private sector to refer used for cross-border surveillance cross-border mechanism successfully, the private sector. Even if you went to malaria cases to the government health of malaria cases, there should be a he stressed. This is a key issue in our containment the villages, the smallest drug retailer centers. 6 3 Fighting Counterfeit Anti-Malarials What are the efforts to eliminate these A Force of Dedication in the Field counterfeit and substandard drugs An interview with Dr. Doung have deployed our people along the incidence of malaria by about under the same regional office based sold by the private sector and also Socheat, Director National Center for Cambodian-Thai border. We have also 50 per cent, I would say,... in Chon Buri, where Ms. Uraiwan enforce the ban on oral artemisinin Parasitology, Entomology and Malaria made big efforts to distribute long- through all activities.” graduated from Burapha University in monotheraphy? Control. lasting insecticide-treated nets (LLINs) The Fixed Schedule Malaria public health. to people in the area. We are also Clinics, which are placed right Difficulties in Cambodia, especially We provide regular monthly trainings making concerted efforts to control on the border with Cambodia, along the border with Thailand to all companies involved in the the sale, by retail outlets and in the “enables us to draw blood compromised Cambodia’s malaria import and export of pharmaceutical markets, of counterfeit and substandard samples and verify quickly control efforts for many years. products. We have also communicated anti-malarials in the targeted area that through microscopy if they to all pharmacies and drug-sellers we call Zone 1. Besides that we are are positively carrying malaria However, having been trained in of the Ministry of Health’s ban on also doing mass screening of children, parasites”. By quickly, she public health, Ms. Uraiwan knows women and men in Zone 1 to diagnose monotheraphies. It is important to and treat malaria. Our aim is to contain inform the drug-sellers first, before we do When Uraiwan Tattong speaks, you have to listen, and eliminate artemisinin-resistant law enforcement with the Justice Police not only because of what she as to say, but because falciparum malaria in Zone 1. who go around inspecting pharmacies her voice has a warmth of tone and quality of texture The results have been very and other drug retail outlets. The drug- encouraging. It is an indication that our sellers have to be made aware of the that would make her a contralto if she were to take up containment strategy is working in the dangers and the harm they could cause singing. high transmission areas. Let me give you with the sale of fake anti-malarials and means 20 minutes. that issues verging on life and death an example. Previously when we first monotheraphies. In this province, these transcend all others, and, through Dr. Doung Socheat, in a quest to eliminate We raise this awareness by constantly falciparum malaria in Cambodia. Pix by WHO/ started mass screening of about 3,000 clinics happen twice a week her work, has tried hard to build trust putting out Information, Education and Sonny Krishnan people we found over 100 positive at three points on the border among nationals of both countries, no falciparum malaria cases. Recently we Communication (IEC) materials, which and began operating since matter what is happening on other There is evidence of artemisinin- did screening of the same size of people are distributed to communities, warning Uraiwan plays a big role in curbing vector-borne diseases in March 2009. fronts. resistant malaria in Western Cambodia, and only found eight positive cases. This of the dangers of monotheraphies and eastern Thailand. Pix by WHO/Anuraj Manibhandu At 54, Ms. Uraiwan has particularly along the Cambodian-Thai drop in the number of positive cases the dangers of buying fake drugs. These Sa Kaeo, Eastern Thailand -- This played a responsible role in curbing border. What efforts are being made is very significant. In 2009, we had no IECs also inform the public that the lady responsible for the province’s vector-borne diseases in this part of to reduce the morbidity and mortality deaths due to falciparum malaria in the government has banned the marketing malaria control activities shows eastern Thailand for some years. She rates there? area, especially in Pailin. and sale of “single-drug” artemisinin dedication and know-how, going out became head of the centre that deals malaria medicines, in order to prevent into the sun to check out a mobile malaria and other diseases carried by We have been working with different Counterfeit and substandard anti- malaria parasites from developing clinic, and presenting power points to mosquitoes here in Sa Kaeo in October partners, especially with WHO, with malarials are one of the causes for the resistance to this drug. a room full of experts pressing her to 2009, after serving in the same position funding from the Global Fund. We emergence of MDR-falciparum malaria. continued on page 3 say more. in Si Racha, further southwest, for two When Uraiwan Tattong speaks, years. ....from page 1 you have to listen, not only because She hesitated to admit that coming Cambodia is making dramatic of what she has to say, but because here was something of a promotion, progress. As of 14 September her voice has a warmth of tone and but she did say that the seaside town 2010, there were only two cases quality of texture that would make of Si Racha, on the Gulf of Thailand, of falciparium malaria from 5,686 her a contralto if she were to take up “is smaller than Sa Kaeo.” Asked what people screened in 16 villages in singing. her sights were in the six years she has Pailin, which previously were the She affirms that the project to left before the mandatory retirement most affected in the border area. contain killer malaria parasites tolerant age of 60, she replied “that’s up to my In the adjacent area in Thailand to artemisinin has had a positive higher-ups.” A mobile clinic along the Thai-Cambodian -- Soi Dao and Pong Nam Ron impact here. “It has helped reduce the Both Sa Kaeo and Si Racha come border. Pix by WHO/Anuraj Manibhandu districts of Chantaburi province -- there was a similar trend, with ....from page 6 “Back then, it was all forests and After he retired from the incidence of falciparum malaria The Khmer Rouge also needed him we couldn’t see the mountains. government’s Malaria Control Centre dropping from sixteen (16) to to fight malaria. Mr. Chheang said the Wild animals were everywhere,” Mr. 15 years ago, Mr. Chheang was seven (7) from 2008 to 2009, Khmer Rouge used herbal and other Chheang said, pointing at deforested hired by WHO to help with malaria the year before the cross-border traditional medicines instead of the mountains in the distance. containment work in the fields. project kicked in and the year modern medication to treat malaria But, it was not only the landscape With almost continuous work after. and other illnesses. that was different. Mr. Chheang to fight malaria for more than half So far, more than half a million Now at the age of 72, Mr. Chheang said they also had far less advanced a century, Mr. Chheang said he still bed-nets have been distributed, is still working in the field in a new facilities to do the work. enjoys doing his job. including more than 260,000 in about 2,900 volunteer village malaria works to undermine the sale of fake and mission led jointly by the Cambodian He said that there was no telephone “I am happy with the work; I am zone 1. A further 200,000 existing workers, or VMWs, in Cambodia and sub-standard anti-malarial drugs from government and WHO, together with in the district and that people had to happy in the village,” he said recently, mosquito nets have been treated with 326 in Thailand. These VMWs are fully the private sector where Cambodians its partners, to contain artemisinin- go to the post office to send mails via with a smile before gesturing at a insecticide. This distribution means trained and equipped to diagnose have usually sought treatment. In both resistant malaria parasites which telegraphs. mother and daughter to go for blood that all villagers in zone 1 and all malaria in the village using a rapid Cambodia and Thailand, treatment for have emerged in the areas along the “Now, people are much more screening for malaria in Pailin’s O Ro’El people in the high-risk villages in zone diagnostic test and to provide the malaria is now available 24-hours a Cambodian-Thai border. sophisticated; they have computers; village. 2 are able to sleep under a mosquito patients with the appropriate drugs day through public health centres and Looking back to more than half they use emails,” he said, adding: Chhean Nariddh Moeun net each night. for free. This strategy – providing free VMWs. a century ago, he said things have “Now, we have a large team that can Meanwhile, the project has trained anti-malarial drugs in the village – also changed a lot. cover all high-risk areas.” 2 7 Malaria Myths Are Becoming a Thing of the Past “YOU are drinking again, darling!” exclaims a Pailin villager to her husband. “Aren’t you afraid of having of drug-resistant malaria on the Thai-Cambodian border a stomach ache?” “No, my dear, I feel a shiver in my backbone,” replies the man to his missus. “I am just drinking once in a Quarterly Newsletter of the Strategy for the Containment of Artemisinin-Tolerant Malaria Parasites in South-East Asia Project while lest I get malaria.” This song lyric from the 1970s is October-December 2010 just one of the many myths some Cambodians have of malaria and how WHO Implements Ambitious Project to Fight Malaria they can protect themselves. However, orking closely with the many people across the country have Wgovernments of Cambodia and other more common myths and Thailand, the World Health Organization superstitions about malaria. has developed an ambitious cross- For many Cambodians on the border malaria containment project move, going into a new cleared area in a bid to eliminate malaria resistant in the forest could mean sickness – parasites and wipe out the mosquito- not because of malaria, but due to borne disease along the border areas the belief that they have not adapted A woman farmer in Pailin appeasing the land spirits. Pix by WHO/Chhean Nariddh Moeun of two countries. to the new land and climate. Others This $22.5-million project, funded believe that drinking water from the conversation for being a place where Mr. Chheang. by the Bill & Melinda Gates Foundation, stream that flows in a ‘new land’ will people could either become rich after Another prevalent myth in Pailin uses a combination of prevention and also make them ill. Cambodians would finding gems or die of the mosquito- involved young people. “They were treatment methods that have proven call this illness “Chanh Teuk, Chanh borne disease. told by the old people to look up into to be effective against malaria. The Dei” in Khmer instead of “Krun Chanh” Therefore in the early days, many the sky when it rained, otherwise they project strategy includes large-scale or malaria. Cambodians were fearful of traveling would get malaria fever,” a malaria distribution of long-lasting insecticide- Forays into the forest also have their to the area in the west of the country. expert in Pailin says, laughing. treated mosquito nets, free early fair share of superstitions. For instance But now, myths and superstitions diagnosis and treatment of malaria if Cambodians have fever after a stint Between the 1960s and 1970s, about malaria are a thing of the past. at the village level, 24-hour health in the jungle, they would blame it on a around 15,000 mostly Kolar ethnic “Myths and superstitions about facilities to diagnose and treat malaria spell or curse cast by the forest spirits. minority people from Burma had malaria have almost disappeared,” and intensive surveillance of positive settled in Pailin, according to Mr. says Dr. Boukheng Thavrin, Chief of cases as well as other education They would call this sickness “Chanh Map showing containment zones Neakta.” Cambodia’s National programmes and innovative means to All these beliefs “The kru Khmer would warn his clients that they could Malaria Centre’s reach the mobile migrants. the health ministries of Cambodia conduct inspections aimed at make the conditions have said something wrong and made the forest spirits Health Education Early last year, WHO warned that and Thailand, and other partners, to uncovering outlets selling these drugs. contain the resistant parasites, with The Ministry of Health in Cambodia of the illness worse. unhappy. And that was the reason for their fever.” Unit. parasites resistant to artemisinin had Instead of trying to Though some emerged along the Thai-Cambodian the ultimate aim of eliminating them has trained 250 “justice police” who from the target regularly check pharmacies, shops get treated with modern medicines, Chheang, who has been a health people still believe that they could zone. and markets to try to ensure that only people give offerings and pray to the worker fighting malaria for more get sick when they go to new land Drugs based recommended malaria drugs are sold. land and forest spirits so that they are than half a century. He said the Kolars clearings or into the forest, she says on artemisinin Activities are being implemented released from a spell or curse. had moved to Cambodia to look for they still sought treatment from alone, rather than in the target zone, known as zone 1 Some people may go to a kru Khmer, gemstones that were abundant in medical doctors. Pailin during those years. “They no longer pray [to spirits] combined with that covers areas where artemisinin or traditional healer, who claims to other drugs, have tolerance has already been detected, have psychic and spiritual power that Whether or not the Kolars knew when they are sick,” she adds. anything about malaria, Mr. Chheang Dr. Thavrin believes that the been blamed for and in a much larger buffer zone, enables him to communicate with contributing to known as zone 2 where there is no says, they had a set of “do” and “don’t” education campaign launched by the ghosts or the spirits. resistance. evidence of tolerance yet, but the rules to follow to avoid getting sick. National Malaria Control Centre had Yeang Chheang, a 72-year-old Because of this, risk is also high. In Cambodia, zone 1 Rule No 1: Don’t take a bath at contributed to people’s knowledge veteran malaria worker in Pailin, the Cambodian covers about 270,000 people in four night; Rule No 2: Wear your hat when and awareness about malaria. explains. Government has provinces - all of Pailin and parts of going out at night; Rule No 3: Don’t “Now they know how malaria “The kru Khmer would warn his now banned the Battambang, Pursat and Kampot. In clients that they could have said pluck and eat ripe bananas, papayas [parasites] are transmitted,” she use of single- Thailand, about 110,000 people live in or oranges from trees. (You should eat explains. “What we are proud of [is the something wrong and made the forest Drawing a blood sample in a finger stick for the PCR tray. PCR technology drug treatments zone 1 - in the border areas of Trat and spirits unhappy. And that was the only the ripened fruits). fact that] people who had never used is highly accurate and capable of detecting minute levels of parasites. Pix for malaria. The Chanthaburi provinces. reason for their fever.” “When the Khmer newcomers got mosquito nets are now using them.” by WHO/Sonny Krishnan project has also Zone 2 in Cambodia covers nine When Cambodians talk about sick with fever, their eating habits border, posing a serious threat to made concerted provinces with a total population malaria, Pailin would be on top of their were blamed for their illness,’’ adds Chhean Nariddh Moeun global efforts to control malaria. efforts to stop the sale of fake and of more than four million, while in Artemisinin-based drugs are the most substandard drugs, which are believed Thailand zone 2 comprises seven effective treatment against malaria to be a major contributing factor provinces with a population of nearly CONTAINMENT is published by WHO Cambodia’s Malaria Containment Project. For enquiries please and have made huge strides over the to the development of resistance. seven million, about 150,000 of whom contact Dr. Najibullah Habib, Malaria Containment Project Manager, World Health Organization past decade in controlling the disease. Through the project, drug inspectors are living in malaria risk areas. Cambodia, 177-179 St. Pasteur (51), PO Box 1217, Phnom Penh OR e-mail: [email protected] WHO has been working closely with have been trained, and now regularly continued on page 2