CONTAINMENT

contain + eliminate = no parasite

‘We Want to Work Closely with the Cambodians’

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Dr Wichai Satimai, Director Bureau of Vector-Borne Diseases, Thailand. Pix by WHO

Interview with Dr Wichai Satimai, Director, Bureau of Vector-Borne Diseases, Thailand.

Please identify one benefit Thailand has enjoyed from the project, mainly supported by the Bill and Melinda Gates Foundation, to contain and eliminate malaria parasites tolerant to artemisinin in Southeast Asia.

The support Thailand has appreciated in particular from the Bill and Melinda Gates Foundation has been the boost in human resources and equipment. With more full time and part-time staff here at the Bureau of Vector Borne Diseases, and in the border areas, including translators at malaria clinics and IT people, and the equipment we need for containment activities – such as motorcycles (42), good microscopes (40), and pickup trucks (seven which replaced 20-year-old ones) —  we have made much progress.

Since malaria control remains on Thailand’s national agenda, which is evident in the Bureau of Vector-Borne Disease’s partnership in the project, how do you think the question of malaria control should be raised?

The malaria situation in Thailand is better than before with incidence down from about 100,000 say ten years ago to about 25,000 now, among Thais and non-Thais.  However, with the emergence of new, epidemics such as SARS, or H1N1, non-communicable diseases and illnesses deriving from environmental and chemical causes, the human resources and budget have to be shared.

With regard to containment of artemisinin-resistance, we would like people in Thailand and other countries around the world to know that this is similar to resistance to Fancidar (sulfadoxine-pyrimethamine), which also spread. It means we have to ask specialists from international organizations to help us. Hence we have to co-operate with the World Health Organization, the Bill and Melinda Gates Foundation, the Global Fund.  At the Global Fund’s Round 7, two research groups participated. We are asking Global Fund Round 10 to include 12 non-governmental organisations that work with us as recipients. We need their experience in working with migrants.  We realise that patients, nearly half of them migrants moving from nearby countries, are undocumented and may be afraid of the government.

The secretary-general of the World Health Organization has made clear that health issues transcend all borders. Please reflect on how this applies to Thailand’s co-operation with Cambodia and other neighbours.

The principle is we would like to work closely with Cambodia. Unfortunately, there is a language problem between Thais and and Cambodians that needs to be improved. This affects containment, because we cannot do follow-up work on people who cross the border after 28 days.

With other countries who share borders with Thailand, for example with Malaysia, and Laos, we do not have as much of a language problem. With Myanmar, many of their nationals cross the border because they accept and know our facilities, and appreciate that these are free of charge, including long-lasting insecticide-treated nets. It’s a push and pull situation.

I agree totally with the WHO secretary general. We cannot stand alone. Thailand has to work with nearby countries. Today (Sept 1), the Department of Disease Control is meeting with Myanmar, whose officers have come to discuss co-operation in tuberculosis and malaria. For nearly nine years, we have our shared our experiences. We have other channels to work together with neighbours.  This includes the capacity-building programme for the Mekong Region countries supported by the USAID and the ADMECs   (Ayewaddy-Chaophraya-Mekong Economic Co-operation Strategy), whose health officers met in Thailand Aug 26-27 to fine-tune activities. All of these come to the same direction: to reduce our burden of diseases.

Please comment on attempts to strengthen surveillance, reporting and health care systems at the tambon level.

We have a vertical programme for malaria control in Thailand. We have a malaria clinic at village level, but it is not in every village, only in some. We have added on malaria posts.  In every village, where there are malaria cases, for more than six months a year, we establish a malaria post. The malaria post workers are chosen from villagers who can speak the local language whom we train to draw blood, use the rapid diagnostic test kits and dispense drugs. This is not at the tambon level but at the village level. The health centre at tambon level [only] carries out rapid diagnostic tests.

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Written by malariacontainment

September 10, 2010 at 10:09 am

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