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The Frontlines of Malaria: A Threat on the Thai-Cambodian Border

October 11, 2011

Travel to Cambodia on Impatient Optimists with John Murphy, a senior writer here at the Bill & Melinda Gates Foundation who recently returned from this region of the world. Over the next three days John's posts, "The Frontlines of Malaria," will bring us the real stories of women, men, and children affected by malaria, as well as health workers, working to prevent, treat, and end malaria.

TA SANH, Cambodia --It’s a bumpy, muddy drive on rutted dirt roads, across fast moving rivers and through thick forests to reach this remote corner of Cambodia–so far away that it seems like it could hardly pose a threat to the outside world.

But a public health risk has emerged here that could have an impact on millions worldwide: drug-resistant malaria.

In 2008, researchers working along the Thai-Cambodian border discovered that the parasite that causes malaria was showing signs of resistance to one of the best drugs we have to fight it.

Malaria, spread through mosquito bites, kills about 800,000 people each year. Most of those deaths occur among children in Africa, yet the disease still remains a fierce foe in many other parts of the world. Here in South-East Asia there were more than 111 million suspected malaria cases in 2009. 

Artemisinin, an ancient root originally found in China, is viewed as one of the most potent drugs available used against malaria. Used in combination with other drugs, artemisinin therapies normally cure patients within 48 hours. But several years ago researchers in Cambodia noticed that malaria patients here were taking much longer to respond to the medication – sometimes a week or longer.

This is not the first time anti-malarial drugs have lost their potency in this part of the world. In the 1950s, chloroquine was the drug of choice for battling malaria. But the parasite evolved, developing a resistance to the drug along the Thai-Cambodian border before spreading to India and then Africa.

Now scientists fear that artemisinin will suffer the same fate. Losing it would be a huge setback in the international efforts to combat malaria.

In response, the World Health Organization, the health ministries of Cambodia and Thailand, and many other partners, including the Bill & Melinda Gates Foundation, teamed up in 2009 to launch an ambitious project to contain the spread of drug resistant malaria.The goal of the effort is to prevent the spread of drug resistance by wiping out malaria altogether in Cambodia.

“We need to protect the artemisinin drug because it’s one of the most effective tools we have against malaria,” said Dr. Najibullah Habib, manager of the World Health Organization’s malaria containment project in Cambodia. “If we lose that drug there aren’t too many other drugs in the pipeline, and millions of people would be at risk.”

From the start, the team knew the job wouldn’t be easy.Battling malaria in the remote villages of western Cambodia requires good coordination, transportation, and communication, all things in short supply in this poor region.

Adding to the complexities, Cambodia’s history of war and civil unrest has made it one of the most heavily mined areas in the world. Ubiquitous skull and cross bone signs warning “DANGER MINES!” are visible alongside almost every road, making travel slow and hazardous. For many years, one of the top causes of death here, after malaria, was land mine accidents.

“It’s a poor area in a poor country,” Dr. Habib said. “Logistical challenges are heavy and it’s not an easy place to work.”

What health officials needed were new ideas and new approaches to fight malaria. What they needed was a new weapon.They found it in the remote villages they were trying to help.

Next: Cambodia's secret weapon against malaria

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