Posts Tagged ‘WHO’
CONTAINMENT’s Moeun Chhean Nariddh caught up with Dengue Fever’s Chhom Nimol in Battambang.
“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.
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.
Moeun Chhean Nariddh reports on a mobile phone-based frontline reporting system for detected malaria cases, implemented in Kampot province.
From her house in Snay Anchit Village, about five kilometers from the health center in Kampot provonce’s Chum Kiri district, 20-year-old village malaria worker Kong Lida can clearly hear the noise of a generator roaring in the distance. This generator is an important source of power where Lida and other villagers have their car batteries charged everyday so that their houses can be lit up at night from electric lamps and at the same time charge up their mobile phones.
But soon Lida and other village malaria workers in her village and other communes will not need to pay the generator owner to have their car batteries charged anymore. Now, all these VMWs will get their power from a ubiquitous source of energy – namely solar power.
As part of the country’s malaria elimination strategy, the National Center for Parasitology, Entomology and Malaria Control or CNM, with technical support from Malaria Consortium (MC) and WHO, has launched a pilot program to train VMWs in Kampot, Siem Reap and Kampong Cham provinces on how to send simple mobile phone text messages (SMS) to report in real time on detected malaria cases. These SMS messages also support the paper reporting that feeds into the health information system from the health centers.
CNM and MC also provide each of the VMWs with a solar panel and a lamp together with a mobile phone and a charger since there is no electricity in their villages.
Cambodia is currently seeing a revolution in communications with the roll-out of affordable wireless services to much of the rural population. The potential of approaches based on mobile phones and web-based technology to address the gaps in field data collection for malaria is now widely recognized.
“I think using a mobile phone is good, because I can report immediately when I come across a malaria case,” said village malaria worker Lida. Previously, the VMWs would record the data in a logbook which they would then report to the health centers at the end of every month before it was sent to the operational district hospitals and finally to CNM.
InSTEDD, an innovative humanitarian technology NGO, designed the system, utilizing SMS messages in Khmer script that interact with mapping software to generate maps on the World Wide Web for the locations of malaria cases reported by the VMWs. These malaria cases are also known as Day Zero cases, to indicate the locations of the patients before they are given appropriate and effective treatment.
CONTAINMENT’s Nat Sumon accompanied an Armed Forces Medical Research Institute for Medical Science (AFRIMS) mobile unit to a remote location on the Thailand side of the border to screen soldiers for malaria.
Over the course of history, in times of war, more soldiers have died from malaria than in direct combat. During the Vietnam War (1962–1975), malaria felled more combatants during the war than bullets. The disease reduced the combat strength of some units by half.
Over 40,000 cases of malaria were reported in U.S. Army troops alone between 1965 and 1970 with 78 deaths. The U.S. Army established a malaria drug research program when U.S. troops first encountered drug resistant malaria during the war. In 1967, Chinese scientists set up Project 523 – a secret military project – to help the Vietnamese military defeat malaria by developing artemisinin based anti malarial formulations.
For the Thai army, malaria still remains a threat despite the drastic fall in cases of falciparum malaria – the most fatal form of the mosquito-borne disease. According to 2010 Royal Thai Army statistics, 572 soldiers contracted malaria along the Thai-Cambodian border and constituted one-fourth of overall malaria patients seeking treatment in the area.
Many Thai soldiers used to harsh tropical jungle conditions are well aware of protective measures. If they fall sick, they are instructed to go either to local malaria clinics or local hospitals to have their blood tested on a weekly basis.
Respondent-Driven Sampling on the Thailand-Cambodia Border: Can Malaria Cases be Contained in Mobile Migrant Workers?
Respondent driven sampling methodology, for hidden populations, is an effective strategy to study the migrant populations from Myanmar and Cambodia on the Thailand-Cambodia border, write Amnat Khamsiriwatchara, Piyaporn Wangroongsarb, Julie Thwing, James Eliades, Wichai Satimai, Charles Delacollette and Jaranit Kaewkungwal in the Malaria Journal.
There is substantial population movement across the Thai-Cambodian border that is largely driven by economics. Migrants from both Cambodia and Myanmar settle for varying periods of time in Thailand, often in search of work. The International Organization of Migration reported that Thailand has attracted increasing numbers of migrant workers, mostly from neighbouring countries with over one million registered migrant workers entering the country since 2004.
Channels for migration, in particular labour migration, are defined by the policy of the destination country, usually in response to the demand of domestic labour markets for foreign workers. When the supply through established channels does not match the demand, irregular migration dynamics develop, and migrants enter illegally and undocumented.
While various government ministries attempt to collect data on migrant workers, they usually have information on the number of registered migrants and those applying for work permits, but little information on the unregistered migrants. The true size of the migrant worker population in Thailand, in particular of irregular migrants, is notoriously difficult to quantify.
Rather than classifying migrant workers as documented or undocumented, the Thailand Ministry of Public Health defines migrants who have been in Thailand for more than six months as M1, and migrants who have been in Thailand for less than six months as M2.
Both M1 and M2 migrants are eligible to receive diagnosis and treatment for malaria free of charge at malaria clinics in border zones. Patients who cross the border for a day to seek treatment at the border clinics are counted among the M2. Migrants in Thailand account for a higher proportion of cases than Thai citizens, especially among the M2 migrants.
The ‘Love Your Health’ radio program hosted by the head of the Malaria Clinic in Khaeng Harng Maew District, Chanthaburi is a community favourite. CONTAINMENT’s Nat Sumon tells why.
If you live in Khaeng Harng Maew district, Chanthaburi, where there is only one strong radio frequency, your favorite entertainment channel would definitely be the local radio network FM95.75.
Among the variety of programs carried by FM95.75, the most popular slot seems to be a one-hour health program every Wednesday called “Rak Sukaphab” or “Love Your Health”. Undoubtedly the listening audience, attracted by the easy-listening music, tune in faithfully every Wednesday to the health program that has helpful tips on how to lead a healthy lifestyle.
“Love Your Health” also has a call-in facility that allows listeners to interact with the presenter Anukoon Charunthup, who is also head of the Malaria Clinic in Khaeng Harng Maew District, Chanthaburi. The program allows listeners to phone in to ask any health-related questions they might have. And as an indication of the radio program’s popularity, the station’s phone is always ringing off the hook.
Anukoon tells CONTAINMENT that he began hosting the “Love Your Health” radio program about five years ago when the local radio network was just launched.
“Chantaburi is no stranger to vector-borne diseases,” he says. “The health topics that I cover in my radio program range from malaria, dengue and other mosquito-borne diseases.”
Anukoon’s radio program is important for Khaeng Harng Maew residents especially during the rainy season. “It’s the rainy season when diseases like malaria and dengue are rife and I use the radio program to disseminate preventive messages and tips on how listeners will be able to protect themselves from falling sick,” he adds.
But there is a humourous side to Anukoon, too. He tells CONTAINMENT that malaria is also known as “khai-mae-yai-bua” in Thai, which means “fever that pisses your mother-in-law off!”
Anukoon explains. “When you have malaria, you can’t work to feed your family, and that’s when the mother-in-law becomes cross because her daughter and grandchildren would have to go hungry.”
The Malaria Clinic head in Khaeng Harng Maew District made it clear that the most vulnerable group to malaria are male wage earners.
“Because of this, my program gives advice on where these workers would be able to get mosquito repellents and insecticide-treated bed nets to prevent themselves from getting malaria,” adds Anukoon. The “Love Your Health” radio call-in program also tells these workers where the locations of the malaria clinics are and assures them that diagnosis and treatment is free of charge.
Though Anukoon believes that local people are very acquainted with malaria, its symptoms, and vector control and prevention measures, he, however, tells CONTAINMENT that they need to be reminded of the dangers of malaria during the rainy season.
Anukoon has been presenting “Love Your Health” for about five years and is now building up the capacity of his staff to co-host the show to add diversity to the radio program and also fill in as main presenters when he has to travel outside the district for meetings and workshops.
“My hope is that by building up the capacity of my staff as presenters, they would in turn be able to start their own malaria radio shows if they are promoted and transferred out of the district,” he explains.
But wearing two hats at one time can be tiring for Anukoon. “I frequently get calls from listeners asking me where I was in the previous week, for instance, because they didn’t hear my voice on radio,” he explains.
But the rewards are always gratifying. “Every week I get e-mails and calls from listeners telling me how much they enjoyed my show and how useful the health messages were to them,” says Anukoon. “That’s enough to keep me going.”
CONTAINMENT’s Moeun Chhean Nariddh profiles a popular interactive radio program on malaria education broadcast from Battambang.
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.
CONTAINMENT recently spoke to Dr. Char Meng Chuor the new Director of the National Center for Parasitology, Entomology and Malaria Control (CNM).
One big concern is malaria on the move. How important is the role of village malaria workers or VMWs in the early diagnosis and treatment of mobile migrant workers?
Yes, indeed, malaria on the move among mobile migrant workers is worrying. But first let me clarify one thing on terminology. I like to refer to the village malaria workers as community health workers because they can also work on other diseases at the community-level. At present in each health centers there are only seven to eight full-time health staff as first-line health workers. And as you know most of the villages are far from the health centers. So we need these community health workers to support the work of the health centers.
When Khmer people fall sick, they end to seek treatment from the nearest source available to them. And most often, these community health workers are nearest to them. For that reason they are so important in the fight to contain multi-drug resistant malaria. These community health workers not only carry out early diagnosis and treatment, but they also provide vital information to the mobile migrant workers on how they can protect themselves against malaria.
Counterfeit and substandard anti-malarials are one of the causes for the emergence of MDR-falciparum malaria. What are the efforts to eliminate these counterfeit and substandard drugs sold by the private sector and also enforce the ban on oral artemisinin monotheraphy?
First of all, we have to ensure that communities must have access to genuine medicines. This is essential. We can ban oral monotherapies, but if sick people do not know where to get effective anti-malarials, we will go back to square one. Secondly I need to emphasize the importance of law enforcement. The elimination of malaria by 2025 is a government priority and so it’s important that legislation is in place for the law enforcers to start the crackdown of counterfeit malaria medicines.
But let us not forget that we have to also work with the private sector through partnerships. We are now drafting the strategy for the public-private mix, in terms of malaria. We’re still in the learning process, when it comes to dealing with the private sector. But there’s a lot of donor goodwill to provide technical assistance. The chink in the armour is the private sector because most Khmers when they fall sick go to the pharmacies or drug stores first. We have to convince the private sector on why they need to be good and responsible providers to prevent a public health emergency that could cross borders.
What are the lessons learnt from the Containment Project, and how can these lessons be used as we move from malaria control to elimination?
CNM has been implementing the containment project since January 2009, and we have many lessons to share. The first and most important lesson is that it is possible to reduce malaria incidence in the target zones through good management and implementation of proven strategies in malaria control, such as high-level coverage of long-lasting insecticide treated bed nets, provision of free diagnosis and treatment at the community level, and engagement of the community through malaria education and awareness programs. CNM, through the support of the Bill and Melinda Gates Foundation and the assistance of technical partners such as WHO, Institute Pasteur and Malaria Consortium, and others, has helped us achieve this.
We have also found that, when malaria cases begin to decrease, the role of systematic gathering of health information, including malaria surveillance and response becomes very important. As malaria cases decrease in Cambodia and we are on our path towards elimination, we need to strengthen surveillance systems to capture information on cases up to the village level, and also concentrate on responding to increases in cases through distribution of bed nets and indoor residual spraying.
Another lesson learned is the need to engage and work closely with the private sector in order to be informed of those malaria cases treated by the private sector, in pharmacies and private clinics, and to provide incentives to the private sector to help in the fight against the sale and manufacture of artemisinin monotherapies, as well as fake and substandard drugs.
Also, we need to be sure to have the full support and participation of communities in the fight against artemisinin-resistant malaria, and also move towards elimination. This can be facilitated through wide-ranging media awareness campaigns, community mobilization through local community organizations and distribution of information, education and communication materials, as well as advocacy by involved leaders and authorities.
Members of the Buddhist clergy certainly have an important role to play in positive behaviour change when it comes to malaria prevention, writes CONTAINMENT’S Moeun Chhean Nariddh.
In a spacious, yet unfinished dinning hall at Serey Mongkul Pagoda near the Cambodian-Thai border in Battambang Province, young and old villagers sing songs and play games with health workers and malaria experts at a handover ceremony, to local villagers, of a positive behaviour change communication project to fight malaria.
Men, women, boys and girls brave their usual shyness and stand up to answer quizzes and questions posted by communication and public health experts from Cambodia’s National Centre for Parasitology, Entomology and Malaria Control (CNM) and the international NGO Malaria Consortium to test their knowledge and understanding about malaria.
In contrast with the mostly blue-collared polo T-shirts worn by staff from CNM, Malaria Consortium and community leaders, about half a dozen monks in saffron robes watch and listen with great attention to how the villagers answer the questions and quizzes.
In fact, these monks are here with a reason. In the campaign to fight malaria, Buddhist monks have been involved to help educate villagers about malaria and how to protect themselves from the mosquito-borne disease.
It is here that Malaria Consortium and CNM, with the support of the World Health Organization’s Containment Project, pioneered an innovative behaviour change communication strategy called ‘Positive Deviance’ or PD. Three villages, Kampong Chamlang Leu, Ploav Praim Muy and Samsep, selected for the study were from Sampov Loun, a district of Battambang province.
The PD approach initiates community dialogue, respects local wisdom and provides social proof by identifying positive practices from within the community which ensure acceptance and expedite the process of behavior change. It allows community members to be active beneficiaries, engaged as full partners to play a role in their own health and protection from malaria.
“I preach Buddhism and teach people about malaria and dengue fever,” explains Venerable Pich Bunthoeun, the 45-year-old abbot of Serey Mongkul Pagoda. He adds: “The monks have a very important role to educate people about malaria.”
Venerable Buntheoun says people give more respect to the monks and will follow their advice when they tell them to do good things.
“When the monks say anything, people listen to them more than ordinary persons,” he says.
The abbot says he and other monks attended a three-day training seminar in Battambang province in April 2009 and learned various knowledge and skills on how people can prevent and get treatment for malaria.
The Venerable says he got enough knowledge to teach people and that people have also known a lot about the disease partly thanks to the teaching by the monks.
“I am happy that people and children have good health,” Venerable Bunthoeun says with a smile, adding that he hopes that he will continue the work to fight malaria.
Loch Yoeum, 60, says she has lived for 13 years in Komrieng District’s Takrey Commune, where Serey Mongkul Pagoda is located.
She says there used to be a lot of forests around these areas and that people were falling sick from malaria, including herself.
Yoeum says the monks have told people to clean the environment, sleep in mosquito nets and to wear long-sleeved shirts to avoid malaria.
“People are poor, so it will be more difficult if they get sick,” she explains.
The findings in Malaria Consortium’s report titled: “The ‘Positive Deviance’ approach to improve malaria outcomes among mobile and migrant workers in Cambodia” indicate that most of the community members and migrant workers believed that men especially mobile and migrant workers, ‘kamakor and kachport’, (corn collectors) are the high-risk group for malaria. The female mobile workers also noted that men are most vulnerable to get malaria as they work at night in the farm or forest.
The Malaria Consortium report, however, has several positive stories one of which is on a migrant worker’s wife.
“A migrant worker’s wife always pack a hammock net in her husband’s luggage, whenever he goes to the farm and reminds him, ‘Eing eing mon chol dek kom plech chang mong’ (Darling! Do not forget to use the bed‐net before you sleep to avoid malaria).”
Dr. Meas Tha, Deputy Director of the National Centre for Parasitology, Entomology and Malaria Control (CNM), says malaria experts and campaigners would involve the monks to help educate people during big festivals such as the World Malaria Day and other national holidays.
He says the monks are more influential and people think that when the monks tell them to do anything they mean to advise them to go along the right path for their happiness.
“The monks are the role model for people to follow,” he says.
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.
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.
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.
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.