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
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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. anti-malarials in the targeted area that products. We have also communicated 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.