CONTAINMENT

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Cambodian Daughter Brings Music and Malaria Messages to Hometown

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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.

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Written by malariacontainment

November 21, 2011 at 4:29 pm

Community Malaria Workers Use SMS to Report in Real-Time

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Malaria Consortium’s Ngor Pengby demonstrating how to charge a mobile phone using a solar panel. This project is in collaboration with Mobitel.Photo by WHO/Moeun Chhean Nariddh

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.

The SMS from a village malaria worker in Khmer script. Photo by Malaria Consortium/Steve Mellor

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.

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AFRIMS Mobile Units Help Detect Malaria

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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.

Thai soldiers line up for blood samples to be taken from them by the AFRIMS mobile unit. Pix by WHO/ Nat Sumon

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.

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Written by malariacontainment

July 21, 2011 at 3:44 pm

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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From Music to Malaria: Rural Radio Key for Malaria Education

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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.

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Written by malariacontainment

July 21, 2011 at 10:42 am

Dr. Char Meng Chuor: ‘We Need Community Support to Eliminate Malaria’

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CONTAINMENT recently spoke to Dr. Char Meng Chuor the new Director of the National Center for Parasitology, Entomology and Malaria Control (CNM).

Dr. Char Meng Chuor. Pix by WHO/sonny krishnan

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.

Customs Department Backs Malaria Elimination Plan with Zero Tolerance for Counterfeits

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Em Khin Vorac, Deputy Director General, Department of Customs and Excise of the Government of Cambodia, speaks to CONTAINMENT’s Moeun Chhean Nariddh in Phnom Penh.

Em Khin Vorac, Deputy Director General, Department of Customs and Excise. PIX by WHO/Sonny Krishnan

How is the General Department of Customs and Excise involved in the fight against counterfeit products and medicines?

With support from the Mekong Priority Solidarity Fund Project, coordinated by the French Embassy, we are active partners with other project members including the Ministry of Interior. We have had a number of meetings and workshops on the joint crackdown on counterfeit products and medicines. Our Customs officers are now positioned at different checkpoints along the land borders with Thailand, Vietnam and Laos. Most of the counterfeits, originating from neighbouring countries, seem to be getting through these checkpoints and for this reason we have increased the number of Customs personnel at these border crossings.

Our Customs officers remain vigilant. Some of these counterfeit medicines are smuggled through in small quantities in people’s handbags. Sometimes, they conceal them with lawful goods. For example, they might conceal about ten small cantons (of counterfeit medicines) with sacks of cement, piles of iron, boxes of cakes and sweets and other items where Customs duties have been paid. Under such circumstances it can get difficult to check all items coming into the country through these land borders.

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Written by malariacontainment

June 29, 2011 at 11:21 am