Cambodian Daughter Brings Music and Malaria Messages to Hometown

CONTAINMENT’s Moeun Chhean Nariddh caught up with Dengue Fever’s Chhom Nimol in Battambang.

Chhom Nimol endorsing a poster urging Cambodians to visit a Village Malaria Worker or the nearest health centre if they have fever. Pix by WHO/sonny krishnan

“Oh, oh, oh, Chumno kadeuk oi own neuk srok, neuk dol yeay ta, mingmear, pa’own bong…Yeung thloip roth leng trosorng, eilov nuon la’orng khleath tov sen chhnay. Oh, oh, oh…

“Oh, oh, oh, winter breeze makes me miss my home town, miss my grandparents, aunts and uncles, brothers and sisters. We used to go for a walk together, but now I am far away from you. Oh, oh, oh…”

Cambodian singer Chhom Nimol of the Dengue Fever begins to sing the first few lines of her newly recorded song “Uku” without music at the request of a journalist from in the studio of Battambang’s National Radio of Kampuchea before her scheduled performance in the evening.

“I used to have malaria in the refugee camp … I was shivering and it was hard for me to endure the fever and chills…”

With or without music, her voice can easily draw attention from the keen audience and listeners through sound waves that travels hundreds of kilometers away from the studio and the open-air live concert.

What makes her performance in Battambang special is that the sound waves not only carry her beautiful voice to the audience, but they also bring along messages about malaria to many people most at risk of getting the disease in remote areas along Cambodia’s common border with Thailand.

Dengue Fever at the free open-air concert in Battambang. Pix by WHO/sonny krishnan

On November 16, Nimol was giving her third performance in Cambodia to Battambang after Kampot and Siem Reap provinces as the front-lady for the Dengue Fever band – a popular US west coast Khmer-American psychedelic rock band. Dengue Fever’s trip to the Mekong region is sponsored by the US Embassy to bridge cultural ties between Cambodia and the United States.

Noting the important occasion and the popularity of the music band, USAID-funded University Research Co., LLC, or URC, had approached the music concert organizers and asked for malaria messages to be read during the event.

“This is a very rare occasion that the Dengue Fever has come to perform in Battambang,” said Kharn Lina, URC’s communications specialist. “Many people in the audience who watched the performance might be working in the malaria-affected areas and could take the messages back to their relatives and friends.”

She said that the recent floods in Cambodia made it even more crucial for people to get enough information and knowledge about how to protect themselves and to get treatment for malaria since there could be more mosquitoes that transmitted the disease to people.

For Nimol, malaria is an illness that will always stay in her mind.

“I used to have malaria in the refugee camp,” she recalls. “I was shivering and it was hard for me to endure the fever and chills when I was young.”

She said it was very important that people sleep in insecticide treated nets so that they could protect themselves from getting malaria.

Nimol said she had spent one year with her family in the refugee camp on the border with Thailand before returning to Battambang in 1992, to resume her education at junior high school level. Cambodia then was under the administration of the United Nations following the end of a 12-year proxy-civil war where battlelines were drawn on then Cold War rivalries. After three years, she said she went to Phnom Penh and continued her studies for another two years.

With encouragement from Chhom Chorvin, her elder sister who was also a singer, Nimol said she started to learn to sing old songs from the 1960s and 1970s by the late Cambodian singers.

Though she was a new singer, Nimol’s voice hadn’t gone unnoticed.

In 1997, she said she decided to register in a song contest organized by Apsara TV in Phnom Penh and won first prize as the best female singer.

She was 16 years old then.

In 2001, she went to the United States and performed at a Cambodian restaurant in Long Beach with her elder sister.

Then, her golden opportunity arrived.

Nimol said Dengue Fever was looking for Cambodian singers at different restaurants in California and they finally came to the Dragon House Restaurant, where she was singing.

“[Dengue Fever] became interested in my voice and body movements,” she said with a smile.

Dengue Fever then invited her to join the band.

In addition to the old songs and music, Nimol said she had also composed new songs like “Uku” herself with help from her American band-mates who composed the music.

“I just do ‘noy, noy, noy’ and they will come up with the music,” she said.

Nimol said she had performed in many countries in Europe apart from the US. However, she said her chance to return and perform in Battambang was just like a dream.

“For me, I am very happy. I just can’t tell you how excited I am,” she said as the cool dry wind started to blow outside, signalling a change in the usual hot humid weather.

From Music to Malaria: Rural Radio Key for Malaria Education

CONTAINMENT’s Moeun Chhean Nariddh profiles a popular interactive radio program on malaria education broadcast from Battambang.

Soeum Chamnan , the radio presenter in Battambang. Pix by WHO/sonny krishnan

As the sun sets in a late afternoon in Cambodia’s Battambang province, many housewives, shopkeepers, farmers and others stay glued to their radio sets to listen to music and songs played from FM radio stations along both sides of the Steung Sangke – a legendary river that was embroidered in many fond Khmer love songs and romantic music from the 1960s and 1970s.

Before too long, this entertainment comes to an abrupt end on the Chamkar Chek National Radio as the clock strikes 5pm.

Unlike the DJs at other private stations who continue playing music or singing karaoke songs along with their listeners, Soeum Chamnan at Chamkar Chek Radio is now engaged in a more serious radio show. She changes from entertaining her audience to helping save lives of people who are at risk of getting malaria.

For an hour from 5pm to 6pm, every Friday, Chamnan’s task is to coordinate a radio talk show, jointly produced by the USAID-funded Malaria Control in Cambodia, Equal Access and the National Malaria Control Center, during which listeners pose questions to experts about how to protect themselves and get treatment for the mosquito-borne disease. The radio program is also fully funded by USAID.

Mon Rubber Tappers Receptive to Malaria Prevention Messages

Despite language difficulties, migrant Mon rubber plantation workers in Thailand’s Trad province give their full cooperation to malaria workers in the fixed-schedule clinics. Nat Sumon reports.

A young Mon migrant at work tapping rubber. Pix by WHO/ Nat Sumon

The economy of Trad, along the Thai-Cambodian border, is fuelled by mobile migrant workers from Cambodia who meet the Thai province’s labour shortages in fruit-picking, rice harvesting, logging, rubber tapping, construction work and retail businesses. But now the economic landscape seems to be changing fast with the influx of migrant workers from Myanmar. And they can be found almost everywhere in Thailand – including Trad’s rubber plantations.

While a worker can make a decent living from tapping rubber, because of the current high global prices, Thais, however, find that job unattractive. Because of this acute shortage of labour in Thai rubber plantations, owners have not much of a choice but to seek workers from neighbouring countries. And mobile migrant workers from Mon State in Myanmar have answered that clarion call, albeit at wages lower than Thais.

Sitting leisurely in his cousin’s thatch-roofed wooden house, Kyaw Htoo (not his real name) recalled his journey from Mon State 13 years ago.  He was a rubber tapper in Myanmar before moving to Thailand. He said the Mon community in Trad had grown over the years, crossing the Thai-Myanmar border in the west to work in the numerous rubber plantations in Thailand’s far-flung eastern province.

“More and more Mon workers cross the border because of word-of-mouth that there are jobs in the rubber plantations,” said Kyaw Htoo.

The number of migrant Mon workers making their way to Trad’s rubber plantations is increasing steadily. Pix by WHO/ Nat Sumon

Nonetheless, there is a public health concern with this influx of Mon migrant workers from malaria-endemic Myanmar. Cross-border and mobile migrant populations could be the source of the spread of multi-drug resistant malaria parasites due to their back and forth travel between malaria endemic areas and their place of work.

Because of these concerns, the fixed-schedule malaria clinics run by the Bureau of Vector-Borne Diseases (BVBD), with technical assistance from WHO, were introduced to the Bill & Melinda Gates Foundation-funded Containment Project to enable on-the-spot detection of the plasmodium parasite in the itinerant workers. These fixed-schedule malaria clinics operate right on the border, in villages where Thailand and Cambodia meet.

Kyaw Htoo and his cousins first got to know about the mosquito-borne disease during the visit of a malaria worker from the Bor Rai fixed-schedule malaria clinic. “There was a language barrier at first. Though we did not fully understand the disease, we now know it’s caused by mosquitoes,” said Kyaw Htoo.

“The malaria worker told us to sleep under insecticide-treated nets, wear long clothes to protect ourselves from mosquito bites while we were out tapping rubber before dawn, and apply mosquito repellent,” added the Mon worker. “We understood that clearly and we are following exactly what the malaria worker told us,” he emphasized.

Aung Naing (not his real name), a cousin of Kyaw Htoo, moved to Trad from Mon State a couple of years ago.

“Whenever I have a fever, I’ll go to the malaria clinic to have my blood tested for malaria,” he revealed. Then he paused and smiled. “So far none of the Mon workers here have tested positive for malaria,” Aung Naing pointed out. “We take seriously all the preventive measures, as instructed to us by the malaria worker.”

Like Kyaw Htoo and Aung Naing, 18-year-old Htun Htun (not his real name) who moved to Trad province after spending five years in rubber plantations in southern Thailand, does not fully understand the causes of malaria. But he told CONTAINMENT that he took the malaria worker’s advice on disease prevention seriously.

An insecticide-treated net hangs alongside the daily apparel of a Mon rubber tapper. Pix by WHO/ Nat Sumon

The usefulness of the early diagnosis and treatment provided by the fixed-scheduled malaria clinics run by BVBD is clearly evident.

Every week Mr. Angkoon Chawilai, one of the malaria workers in Bor Rai Malaria clinic, would visit the rubber tappers in his area to do blood tests and administer treatment if there are positive cases, give out ITNs and mosquito repellents and educate the Mon populations on malaria prevention.

“The local people know me and I’ve always have had good cooperation from the rubber tappers,” said Mr. Chawilai. “The Mon rubber workers are very receptive to malaria prevention information,” he added.

The malaria worker revealed that Mon migrant workers in the rubber plantations were less mobile compared to those migrant workers involved in logging and seasonal fruit-picking.

“This is a positive point when it comes to malaria containment because their movements are controlled as they’re not moving about from place to place spreading the malaria parasite,” Mr. Chawilai pointed out.

Lessons Learned from Cambodia Useful for Region

Cambodia Task Force Meeting in progress. Pix by WHO

The lessons learned from the feedback at the meeting of the National Task Force of Cambodia will be useful to other countries in the Greater Mekong Sub-region in the push for a regional containment agenda towards the elimination of artemisinin-resistant falciparum malaria.

This was the message put forward by the Secretary of State for the Ministry of Health, His Excellency Chou Yin Sim, when he opened the third Cambodian Task Force meeting on December 3, 2010 at the Phnom Penh Hotel.

“The National Task Force of Cambodia provides national supervision to the Containment Project funded by the Bill & Melinda Gates Foundation,” he told the meeting attended by WHO, the National Malaria Control Centre (CNM), and their working partners.

“Elimination of resistant malaria parasites will remain out of reach unless we pay adequate attention to the delivery of health services, including good surveillance of remote areas and migrant populations. This cannot be done without the strengthening of health systems,” stressed H.E. Yin Sim.

H.E. Yin Sim pointed out the strategies that have been effective in the Containment Project.

“The strategies that have been found to be effective in the Containment Project have been the provision of free diagnosis and treatment by village malaria workers and the promotion of the use of LLINs (long-lasting insecticide treated nets) by populations at risk of malaria, especially those who stay overnight in the forest,” he told the meeting.

Another important strategy was the ban on monotherapies that H.E. Yin Sim said had proven to be effective in addressing the spread of multi-drug resistant falciparum malaria.

“The Ministry of Health is committed to eliminating monotherapies and perpetrators will be subjected to administrative measures and legal action,” he said.

“In Cambodia, a ban on monotherapies together with the Public-Private Mix initiative have achieved almost zero prevalence in artemisinin monotherapies as well as a significant reduction in fake and substandard drugs on the market,” said H.E. Yin Sim.

“I do hope this positive example and the lessons learned can be replicated in other countries in the region,” he emphasized.

To reduce drug pressure we also have to engage the private sector – it’s a partner we have to engage with and we are trying work with them and develop strategies to do so…

Schoolgirl’s Malaria Knowledge Helps Family Avoid Getting Sick

Fourteen-year-old Seub Saren who educates her family in Pailin about malaria. Pix by WHO/Sonny Krishnan

“Malaria is spread by female ‘nail’ mosquitoes during nighttime.”

“To avoid getting malaria, people should protect themselves from being bitten by female ‘nail’ mosquitoes by sleeping in a mosquito net.”

“People who have malaria must take proper medicines as prescribed by a physician.”

This is Lesson 11 at Grade 5 in Cambodia which young Cambodian students are taught at school as part of the curriculum for their “Applied Science” study.

However, like other lessons about such diseases as typhoid and dengue fevers, malaria is not an interesting lesson for many students who live in non-malaria infested areas.

But for 14-year-old Seub Saren who has attended a school in Siemreap Province’s Srey Snom District, she finds this knowledge about malaria particularly interesting and useful for her family when they moved to Pailin, where malaria posed a serious health threat to migrant workers like her family.

“After she returned from school, she told the family how to protect ourselves from malaria,” says her father, Se Seub, who is now living and working in Pailin with his wife and four children.

Seub says he was sick with malaria when he came to work in Pailin three years ago and that he had to go back to Siemreap for treatment.

However, he says he has never been sick with the disease during the last few years after learning to protect himself and his family as his daughter taught them.

Seub Saren says she knows very well about malaria from the lessons she has learned at school, which was why she could educate her family how to prevent the disease.

Like Seub Saren, other fifth graders in Pailin can also easily score a good mark for the lesson about malaria.

Unlike many other lessons about Science that is complicated and difficult to learn, Nuon Phon says teaching malaria as a subject in Pailin is very practical and relevant.

Distribution of Bed Nets – A Photo Story

Pix by WHO/Elizabeth James

The World Health Organization has been working intensely with the health ministries of Cambodia and Thailand, in a Bill & Melinda Gates Foundation-funded project, to try to wipe out malaria along the Thai-Cambodian border. Encouraging widespread use of mosquito nets is a key part of the strategy to contain the drug resistant malaria parasites. See photos