CONTAINMENT

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Respondent-Driven Sampling on the Thailand-Cambodia Border: Can Malaria Cases be Contained in Mobile Migrant Workers?

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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.

Migrant workers in Chantaburi on the Thailand side of the Thai - Cambodian border. Pix by WHO/Nat Sumon

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.

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Jill-of-all-trades: A Mother, Midwife, Microscopist, and More Medical Skills

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Chhean Nariddh Moeun profiles Ta Sanh Health Centre’s microscopist Tith Phanny.

Microscopist Tith Phanny…from the battlefield to the laboratory. Pix WHO/Chhean Nariddh Moeun

In this remote village in Samlaut district where Hollywood actress Angelina Jolie adopted a Cambodian boy, pregnant women come to Ta Sanh Health Center to give birth to their babies or get their pregnancy checked. Other patients come here to get their blood tests and treatment for malaria, TB or HIV/AIDS.

However, many of them have one thing in common: the health centre worker who sees and treats them is the same person. And that person is nobody other than Tith Phanny.

As a former Khmer Rouge medic, Phanny says she had been trained as a midwife, a microscopist, and to provide blood tests and treatment for malaria, TB and HIV/AIDS.

Phanny, who thinks she is 50 minus or plus a year or two, reckons that she has helped several hundred women deliver their babies since she became a midwife in the early 1990s.

She says that she remembers helping deliver a baby for a pregnant woman who came to Ta Sanh Health Center 18 years ago. The baby was born as a healthy girl and grew up in the village near the Cambodian-Thai border once controlled by the Khmer Rouge.

“Some babies of the women I helped with their childbirth in the past have grown up, got married and come to deliver their own babies,” she proudly talks of the two generations of mothers she has helped.

Due to the lack of health workers, Phanny says she had learned her different medical skills from her hands-on experience working with various Khmer Rouge medics during the civil war in Cambodia.

She was assigned to do various things, including taking care of wounded soldiers and treating malaria patients who she thinks sometimes outnumbered the wounded…

Back then, she says she was assigned to do various things, including taking care of wounded soldiers and treating malaria patients who she thinks sometimes outnumbered the wounded.

Phanny says it was her own tragic past that had encouraged her to determine to help others.  While living in a children’s mobile unit in Kandal province under the Khmer Rouge, she says she was separated from her family when the Vietnamese forces defeated the Khmer Rouge in 1979.

She says she had to follow others to the Thai border, where the fighting was very tense. In the 1980s, she says she was wounded twice — first in her head by shrapnel from a rocket fired by the Vietnamese and second when she stepped on a landmine and lost her right toe.

Miraculously, she survived the two incidents. Yet, it was not the end of her ordeal.

Phanny says she almost died several times from the scourge of malaria in the 1990s. She says she once went into a deep coma and had to receive successive intravenous drips several months before she regained her consciousness and recovered.

In 1996, the Khmer Rouge struck a deal with the government to end the war. It was the first time Phanny says she could enjoy peace after more than two decades of civil war and fighting.

After the Khmer Rouge was reintegrated into the Cambodian society, Phanny says she was sent to Phnom Penh and Battambang province for one month each to attend formal training in midwifery.

However, Phanny says she still juggles between different jobs at the Ta Sanh Health Center, from midwifery to microscopy, to blood tests and treatments for malaria, TB and HIV/AIDS.

She is indeed a busy woman. As Phanny is working on her microscope in the laboratory, she receives an urgent call to help deliver a baby for a woman.

“I run back and forth from the laboratory to the delivery room,” she says, adding she stays at the health center seven days a week.

Dr. Pov Pheng, deputy Chief of Ta Sanh Health Center, speaks highly of Phanny.

“She is very active,” he says, “She is very diligent in her work.”

Despite the hard work, Dr. Pheng says Phanny and other health workers at his hospital receive the same monthly salary of about $70. Yet, he says the amount is almost ten times more, compared to 10 years ago when they were paid only about eight dollars per month.

Regardless of the money she gets, Phanny never complains about her job.

“I am here 24 hours [a day],” she says, “I am always busy [but] I am happy with the work.”

Written by malariacontainment

March 25, 2011 at 1:44 pm