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The Frontlines of Malaria: Cambodia's Secret Weapon Against Malaria

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.

O TRENG VILLAGE, Cambodia—When Phon Phalep, a rice and maize farmer along the Thai-Cambodian border, woke up feeling ill on a recent morning, he at first thought he was just tired from working too much in his fields.

But when he developed a fever, chills, and severe aches, he asked his family to call for Bun Hoy.

Bun Hoy is chief of this tiny hillside village of bamboo huts and small farms. A one-man government, Hoy rebuilds the village’s wood plank bridge when heavy rains wash it out, represents his community’s interests in the province, and settles disputes between neighbors. 

He’s also one of Cambodia’s newest and most effective weapons in the fight to stop the spread of drug-resistant malaria.

Cambodia’s battle against malaria is spearheaded by more than 3,000 villagers who have volunteered to work in their communities to wipe out the disease. Despite little formal education, volunteers like Hoy have been trained to diagnose malaria, provide treatment, and educate their communities about the disease.

“They’re the heroes of this project,” says Dr. Najibullah Habib, a malaria containment project manager in Cambodia for the World Health Organization.

Before the village malaria worker program, patients like Phalep would need to travel long distances on often impassable roads to reach the closest health clinic. Many villagers with malaria were reluctant to seek medical care because of the inconvenience, putting themselves and their communities at risk.

Now the village malaria workers provide the first line of defense against malaria on their neighbors’ doorsteps.  When Hoy got the call for help, he walked the half mile to Phalep’s home, took his temperature, and then drew a blood sample. Hoy dropped the blood into a rapid diagnostic test, a disposable plastic device about the size of a stick of chewing gum that can provide a malaria diagnosis within 20 minutes. Phalep tested positive, and Hoy administered the first dose of malaria medication.

Phalep fits the profile of most malaria victims in Cambodia. Unlike Africa, where most of the victims of malaria are children, in Cambodia, working age men who labor in the forests clearing land for farming are at highest risk for the disease.

Malaria is also a financially devastating disease for many families here. When the men are sick, the family falls behind in the farm work, missing opportunities to plant or harvest. That’s why keeping every family healthy in the village is Hoy’s number one priority, he says.

Achieving that goal is not easy. Each malaria case is a huge time commitment for the village volunteers, who have their own farms and businesses to run.

Just consider the amount of the work that went into Phalep’s case: After diagnosing and treating Phalep, Hoy returned the next day to make sure he took his medications properly. He then returned the third day to check on his progress.  

Phalep was resting on the porch of his bamboo home, feeling tired but without a fever. Hoy pricked Phalep’s ring finger, squeezed out a drop of blood, and then smeared it on a slide to bring to a lab for examination.

Without any delivery service available, Hoy took on that job too. He hopped on his motorcycle for an hour-long ride along windy dirt roads to the closest health center. There, a lab technician examined the blood samples under a microscope to determine if any evidence of the malaria parasites remained.

If there are still parasites after three days of treatment, it indicates that the malaria parasite is showing signs of resistance to the malaria drugs. In Phalep’s case, the parasites had been eliminated.  He was cured.

But Hoy’s job was still not done. He pulled on his helmet, started his motorcycle, and headed back to his village to give Phalep the good news.

Letting the patients know they’re better is the best part of the job, he told me.

“They’re always happy and excited.”

Next: An end to malaria? 

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